The Orthobullets Podcast Foot & Ankle | Foot Puncture Wounds
Dec 9, 2025
This discussion dives into the complications of foot puncture wounds, detailing the epidemiology and risk factors for infection. Listeners learn about the primary pathogens involved, including S. aureus and Pseudomonas. The clinical presentation is explored with insights on swelling and drainage. Imaging techniques like X-rays and MRIs are highlighted for diagnosing osteomyelitis. The podcast further discusses nonoperative care, surgical approaches, and antibiotic strategies to effectively manage these injuries.
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Punctures Often Hide Serious Infection
- Foot puncture wounds commonly lead to delayed infections and occasional osteomyelitis despite minor initial appearance.
- Early clinical inspection and suspecting deep infection are key because radiographs may be normal early on.
Different Bugs For Soft Tissue Vs Bone
- Staphylococcus aureus most commonly causes soft tissue infection after puncture wounds while Pseudomonas most commonly causes osteomyelitis.
- Patients may present weeks later with swelling, erythema, drainage, or lymphadenopathy.
Use Imaging Wisely — X‑ray Then MRI
- Obtain AP and lateral radiographs to look for foreign bodies and later bone destruction, but expect early films to be normal.
- Use MRI when concerned for osteomyelitis and plan it before operative irrigation and debridement if possible.