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Re: Foot punctures

PostPosted: Tue May 15, 2012 3:42 pm
by MoapaPk
It may be tough to look at the bottom of your foot... but if you see red streaks radiating out from the puncture site, get antibiotics right away.

Re: Foot punctures

PostPosted: Tue May 15, 2012 4:28 pm
by ExcitableBoy
Puncture wounds like the one you describe are particularly dangerous due to other organisms in addition to Pseudomonas spp. The anerobic soil bacteria, Clostridium tetani, can infect deep puncture wounds where anerobic conditions deep in the wound allow it to grow. This bacteria synthesizes endotoxins and causes a disease called tetanus. If you have not had a tetanus vaccination within the last 10 years you should get one. The vaccination is pretty safe, whereas antibiotics can have serious side effects and should not be taken unless a positive culture indicates a bacteria infection is present. The culture should also indicate the least harmful antibiotic that the bacteris is susceptible to. Also, if you haven't done so yet, the wound should be irrigated with sterile saline using a syringe. This can be effectice at washing out any bacteria and obviating the need for antibiotics. As for recovery time, it is impossible to say. If after a week you are not feeling better I would see a podatrist.

Re: Foot punctures

PostPosted: Tue May 15, 2012 7:24 pm
by ExcitableBoy
I agree with twoshuzz. Unless your health problems are diet related, naturopaths are not going to be super helpful. On the flip side my daughter had a number of health problems that no western doc could puzzle out. A trip to a naturopath determined she was lactose intolerant as well as allergic to some very common foods. A simple change in her diet eliminated all her problems.

Also, naturopaths are weary of antibiotics for good reason, some of them have very serious side effects. I have permanent nerve damage in the entire left side of my body due to a bad reaction to an antibiotic. Most western docs do not consider potential side effects of the drugs they prescribe. A palliative care doc prescribed a ketamine creme for my burns. (Yes, the date rape drug). I asked him if it was safe to use on open, raw skin and he said no problem. I asked the pharmacist the same question and she said "Good G-D, no! I need to call your doc to set him straight!".

Re: Foot punctures

PostPosted: Wed May 16, 2012 12:32 am
by philoparts
I'll agree with the last few posts about seeing a real doc. Tetanus shot, thorough cleaning, watch for signs of infection.....yep, pretty much whats been said already. You may also consider instead of just a Tetanus shot getting your TDAP.

http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-td-tdap.pdf

Pertussis (whooping cough) is at almost epidemic proportions in several states right now, and even though adults may not show any symptoms or their symptoms aren't severe, it is easy to pass on to infants and children where it tends to be a much more severe infection, such as pneumonia. Easy to just get 3 for 1 shot and cost is pretty much the same.

Re: Foot punctures

PostPosted: Wed May 16, 2012 2:41 pm
by Sierra Ledge Rat
Lionel wrote:...A naturalistic doc :roll: refused to prescribe an antibiotic...


One word:

M-A-L-P-R-A-C-T-I-C-E

When your foot gets infected, you have an air-tight malpractice lawsuit.

Re: Foot punctures

PostPosted: Wed May 16, 2012 3:09 pm
by ExcitableBoy
Sierra Ledge Rat wrote:
Lionel wrote:...A naturalistic doc :roll: refused to prescribe an antibiotic...


One word:

M-A-L-P-R-A-C-T-I-C-E

When your foot gets infected, you have an air-tight malpractice lawsuit.


Naturopaths cannot prescribe drugs. No malpractice suit there.

Also, there is no small claims court for medical malpractice. No lawyer will take a case on contingency unless you die, lose a limb, or are otherwise horribly and irrevesibly fucked up. I burst a disk at work. Because it was an on the job injury I went to a 'special' doctor that deals with on the job injuries. These are doctors who are so bad they can't get work even as military or prison docs. The reason for this is L&I pays so little and requires a lot of paperwork. He misdiagnosed me with a muscle pull. The disk became infected and eight torturous months later I had to have two surgies and a 6 week hospital stay to replace two infected vertebrae. The team of four orthopedic surgeons each said it was the largest surgery they had scrubbed in on. My vertebrae were the consistency of "cottage cheese" from the osteomylitis. I was plenty fucked up, but because I had an extrodinarily skillful surgeon I made a good recovery (the L&I doc released me from his care, said I was faking a back injury to scam drugs and time off work so I was able to get a private practice doc. He even misread the MRI, the same MRI the surgeon looked at for 5 seconds and told me I need emergency surgery otherwise I would die). I still have nerve problems and cannot have kids, but returned to running ultra marathons and climbing big hard mountains. No lawyer would take my case, my outcome was simply too good to get a large judgment or settlement.

Re: Foot punctures

PostPosted: Wed May 16, 2012 6:57 pm
by Sierra Ledge Rat
I have never seen a plantar puncture wound that didn't get infected. At the very least the wound should have been "cored" to enable it to drain and to prevent it from closing up.

Pain and inability to bear weight, in excess of what can normally be expected for such an injury, is an early sign of infection.

Re: Foot punctures

PostPosted: Wed May 16, 2012 7:41 pm
by Sierra Ledge Rat
Without seeing you, I can't say. You have to decide if you're healing at the expected rate.

Cored: cutting a conical shaped hole in the bottom of your foot up through the puncture tract, i.e., cutting out the core of the wound tract.

I would have been very aggressive: coring the wound, placing your leg/foot in a splint, crutches with no weight bearing, antibiotics, etc.

Re: Foot punctures

PostPosted: Wed May 16, 2012 8:15 pm
by MoapaPk
"the best thing is for your body to pustulate those out". Really?! The best thing is to develop an infection and not to clean the wound to allow for a rapid, non-infectious recovery?


A splinter can pustulate out without a severe infection setting in. I've had big pieces of cactus spines that have been in me for weeks to months, then suddenly popped out (you can imagine the rest of the stuff that comes out). But once I had a spine wound that got infected, and within 2 days I had red streaks radiating out from the site. The doc immediately gave me antibiotics. The streaks cleared up within a day, and eventually the spine popped out in the normal way.

On average, I have had at least one large spine/splinter per month for 10 years-- the foreign objects either came out by pustulation, or via sharp knife and tweezers. Only that one got badly infected; that spine punched up through the side of my boot, probably taking a lot of skin flora with it.

Re: Foot punctures

PostPosted: Wed May 16, 2012 8:45 pm
by Tonka
I had a good buddy on my vollyball team cut his planters last summer on a piece of glass in the lake. The big issue he ended up having was as it healed everything on the outside seemed fine and he could comfortably walk so after a few weeks he rejoined the team. The very first time he went up at the net and came down he dropped to the ground in horrible pain. He says pain on a level he had never felt before. The PF takes a long time to heal so really take it easy. His was a cut not a puncture so hopefuly you'll heal faster but he could not do anything athletic for the rest of the summer outside of walking.

Re: Foot punctures

PostPosted: Fri May 18, 2012 11:21 am
by e-doc
Sierra Ledge Rat wrote:Cored: cutting a conical shaped hole in the bottom of your foot up through the puncture tract, i.e., cutting out the core of the wound tract.

I would have been very aggressive: coring the wound, placing your leg/foot in a splint, crutches with no weight bearing, antibiotics, etc.

Are you mad?

A simple puncture should heal rapidly. You don't need to throw antibiotics at every wound.
After a few days you likely only have point tenderness but the chance of infection; Pseudomonas, Staph, Strep or other is low. This is provided free of charge from someone who has a medical license. (BTW, I didn't get to all the posts, I got swimmy headed reading everything.) Cheers.

Re: Foot punctures

PostPosted: Fri May 18, 2012 5:20 pm
by MoapaPk
Amputation of the foot may be effective. The foot with the puncture, that is.

Re: Foot punctures

PostPosted: Fri May 18, 2012 6:47 pm
by colinr
Well, I hope the verdict is that Lionel gets to go on the big hike or at least can get back to hiking soon.

My uncle, the doc/hospitalist in Tuscon (previously in Silver City), also cautions against overuse of antibiotics. My sister in law, the local vet, takes her kids to an old traditional doc who seems to prescribe antibiotics to them often for stuff my kids tough through without prescription medication. Sometimes it seems to me like some folks place an overemphasis on attempting to remove minor suffering from the human condition...Not that any of that really means much coming from someone who is not a doctor.

While not as often as some have described, I too have allowed some hard to remove splinters to puss their way out. Also, I suffered a small surface cut on the bottom of the arch of my foot while walking barefoot at some hot springs Monday. I have simply tried to keep the area clean and put some A+D ointment or antibiotic ointment on it every once in awhile. There is still a lot of point tenderness today. Fortunately/unfortunately, I think it is just a painful area to injure and Lionel's injury sounds much worse than mine. Surely it is less painful than watching this Vegas video while recovering from foot amputation (assuming & hoping there was no serious infection).

[youtube]http://www.youtube.com/watch?v=2-h3HmoZjLs[/youtube]

Edit: Lionel, glad to hear the good news! At least you'll have a detailed story to think back on and laugh about on your next big hike!

Re: Foot punctures

PostPosted: Fri May 18, 2012 8:01 pm
by MoapaPk
I have a friend who got the broken tip of an agave leaf -- a sharp spike 2-3 cm log -- stuck in his shin in 2009. Perversely, this was a trip down Moapa Peak, while on the cliffs, so we really couldn't just stop. He got down the cliffs, but the muscle action in that time worked the spine deeper into his leg. I tried for about 10 minutes to fish the spine out with sterile tweezers, but I could see that the process was painful, so I stopped and just bandaged the wound. We still had about 2 miles to get back to the car, all on rough terrain, and the spine worked in further. He went to the doc that eve, and the doc just gave him antibiotics. There is still a hard lump there, but the spine seems to have been resorbed by the body -- for the most part (the silica is probably still there).

Re: Foot punctures

PostPosted: Fri May 18, 2012 11:00 pm
by RayMondo
Punctured my foot right through my boot and into the ground with a garden fork, when I was a kid. There was less awareness in those days. Didn't cause me any problems and hardly hurt. Lucky, maybe. Though, seeing as the puncture was top down (clean side), and the dirt cleaned off the fork when I pulled it back through the boot, maybe no dirt or bugs entered.