Migration of a Toothpick along the Flexor Tendon Sheath in the Lower Extremity

Abstract

The most common foreign bodies seen in the foot are sewing needles, toothpicks, glass, and materials such as sand or silica. Foreign bodies in the foot are usually embedded, and surgical exploration and removal is usually necessary. Penetrating foreign bodies in the foot-particularly of organic origin, like wood-can cause cellulitis, osteomyelitis, abscess formation, and pseudotumor formation. Identification of foreign bodies in the foot can be challenging because they are often not radiopaque. However, foreign bodies in the foot do not migrate, in contrast to upper extremities, where foreign bodies are known to migrate. We report a case of a toothpick penetrating a child's foot and moving proximally along the tendon sheath.

Possible Migration of an Antecubital Entry Sewing Needle to the Axillary Region: Case Report

“…It is known that rapid migrations reported in the literature generally occur as a result of vascular transport [13][14][15][16]. It is known that migrations that occur along the tendon sheath occur relatively slowly [5,6,17]. Since the migration that occurred in our case probably occurred through the fascia, it seems more likely that the progression occurred rapidly with the contractions of the muscles.…”

“…Since the foreign body in our case was metal, direct X-ray and tomography tests were sufficient in the evaluation. It may be necessary to use ultrasonography and MRI, especially with penetrations of woody material such as toothpicks [17,19]. Injuries with potential mortality have also been reported, such as needles advancing toward the cardiac area or those that have led to peritonitis after vascular access [13,14].…”

A Child with a Painful Foot: How to Get a Definitive Diagnosis

“…The detection of a wooden foreign body is essential because it is an excellent medium for microorganisms [ 1 , 3 , 5 – 7 ]. If it is not recognized in an early stage, symptoms like cellulitis, abscess, or fistula formation could arise.…”

“…Previously reported article data were used to support this study and are available at DOI 10.3944/AOTT.2015.14.0146; 10.2214/ajr.178.3.1780557; 10.1016/0002(82)90603-1; 10.1016/j.cpm.2012.02.002; 10.7547/16-095; 10.1016/j.fas.2009.04.006; and 10.1177/1938640016656784 and PMID 26554284 and 7982157. These prior studies (and datasets) are cited at relevant places within the text as references [ 1 – 9 ].…”

“…A thorough and systematic approach of a patient with this kind of trauma is essential and prevents more complex problems. In the case of foreign bodies of organic origin, such as wood, cellulitis, osteomyelitis, abscess formation, and pseudotumor formation can occur [ 1 ].…”