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Evaluation and management of plantar puncture wounds.

The true incidence of plantar puncture wounds is not known since all patients who suffer these injuries do not seek immediate medical attention; an unknown number of patients tend to seek treatment only when complications occur (Inaba, Zukin, & Perro, 1992). A study by Reinherz and associates in 1985 reported that approximately 7.4% of all patients seen with lower extremity trauma were seen as a result of plantar puncture wounds. Chisholm and Schlesser (1989) report that early presenters (within 24 hours of injury) are usually children brought in by their guardian, adults with on-the-job injuries, or patients seeking tetanus prophylaxis. The peak time incidence of plantar puncture wounds appears to be in the warmer months between May and October (Fitzgerald & Cowan, 1975). The most common penetrating object is a nail. In fact, Fitzgerald and Cowan (19’75) reported that nails were the penetrating objects in 98% of their patients. Other objects, including glass, wood, and metal, have also been reported (Montano, Steele, & Watson, 1992; Resnick 8c Fallat, 1990). Complications following plantar puncture wounds are well documented. Osteochondritis and pyarthritis, most often due to Pseudomonas, continue to be the most serious complications, and also the most publicized. Other complications, such as cellulitis and soft tissue abscess, are not as widely documented (Inaba et al., 1992). EVALUATION AND MANAGEMENT