Plantar puncture wounds in children: analysis of 80 hospitalized patients and late sequelae

Isr Med Assoc J. 2003 Apr;5(4):268-71.


Background: Puncture wounds in the feet of children present a clinical dilemma.

Objectives: To evaluate our approach, we reviewed the charts and all available images of 80 children admitted to our institution because of plantar punctures from 1988 to 1999.

Methods: The charts of 80 children were reviewed retrospectively.

Results: Three groups of patients were found: 59 with superficial cellulitis, 11 with retained foreign bodies, and 10 with osteoinyelitis and/or septic arthritis. There was a significant presentation delay in patients from the second and third groups. Most common organisms were Staphylococcus aureus or Group A Streptococcus. Of the 80 children, 34 were treated surgically and 46 were treated with antibiotic therapy alone. All patients with osteomyelitis and septic arthritis were re-examined; at follow-up, all but one were asymptomatic apart from residual radiologic sequelae in four.

Conclusions: Patients with an established infection 24-36 hours after a plantar puncture should be admitted to hospital for parenteral antibiotic therapy. Delayed presentation is a significant marker for deep-seated infection. Further infection or relapse after initial improvement suggests the presence of osteomyelitis or a retained foreign body. A bone scan is advisable in all patients with suspected osteomyelitis: a positive bone scan necessitates aggressive early debridement combined with appropriate antibiotics; while negative bone scan, X-ray and exploration suggest that the infection is due to a foreign body, which can be detected by computed tomography.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Debridement
  • Female
  • Foot
  • Foot Injuries* / diagnosis
  • Foot Injuries* / etiology
  • Foot Injuries* / surgery
  • Foreign Bodies / diagnosis
  • Humans
  • Infant
  • Male
  • Osteomyelitis / diagnostic imaging
  • Radionuclide Imaging
  • Retrospective Studies
  • Wounds, Penetrating* / diagnosis
  • Wounds, Penetrating* / etiology
  • Wounds, Penetrating* / surgery