II. Pathophysiology

  1. Puncture through Rubber soled shoe
  2. Classic example is sweaty tennis shoe

III. Complications

  1. Osteomyelitis (osteochondritis)

IV. Symptoms

  1. Persistant symptoms >4 days post-Plantar Puncture Wound

V. Signs

  1. Metatarsal neck to distal toes most often affected

VI. Labs: Evaluation for Osteochondritis

VII. 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

VIII. 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

IX. Management: Antibiotics

  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

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