• See Also
  1. Plantar Puncture Wound
  • Pathophysiology
  1. Puncture through Rubber soled shoe
  2. Classic example is sweaty tennis shoe
  • Complications
  1. Osteomyelitis (osteochondritis)
  • Symptoms
  1. Persistant symptoms >4 days post-Plantar Puncture Wound
  • Signs
  1. Metatarsal neck to distal toes most often affected
  • Labs
  • Evaluation for Osteochondritis
  1. Complete Blood Count (CBC)
  2. Erythrocyte Sedimentation Rate (ESR)
  • Radiology
  • Evaluation for Osteochondritis
  1. Foot XRay (frequently normal)
    1. Periosteal reaction
    2. Bone or cartilage destruction
  2. Osteochondritis tests with higher sensitivity
    1. Bone scan
    2. Foot MRI
  • Differential Diagnosis of Osteochondritis from puncture
  1. Pseudomonas Osteochondritis (90% of cases)
  2. Beta-hemolytic Streptococcus
  3. Klebsiella
  4. Serratia Marcescens
  5. Bacteroides Melaningogenicus
  6. Escherichia coli
  7. Proteus Mirabilis
  8. Staphylococcus Aureus
  9. Salmonella typhi
  1. Prophylaxis of Pseudomonas infection is not indicated
  2. Suspected Sweaty Tennis Shoe Syndrome
    1. Ciprofloxacin (avoid under age 16 years)
  3. Pseudomonas Osteomyelitis (Osteochondritis) coverage
    1. Ceftazidime
    2. Cefepime
    3. Ciprofloxacin
  • References
  1. Gilbert (2002) Sanford Guide, p. 2
  2. Baldwin (1999) Pediatr Rev 20(1):21-3 [PubMed]
  3. Patzakis (1989) West J Med 150:545-7 [PubMed]
  4. Wedmore (2000) Emerg Med Clin North Am 18(1):85-113 [PubMed]