‘stepped on a nail’…

13 Aug

…through a shoe. Happens, and not just in your medical textbooks.


staph or strep can infect foot as well as pseudomonas. Psuedomonas usually appears later about 5 days down the road. Staph or strep often forgotten about bc on every test they want you to know that pseudomonas lives in shoe soles.

If presents with such an injury, I’d consider an x-ray to make sure no foreign bodies or bone injury (this anecdotally is quite rare, but would suck to miss).

Make sure UTD on tetanus status.

Then DC home with close monitoring vs. empiric antibiotics. If returns in 2-3 days with swelling and apparent infection, it likely is due to strep of staph. If it is around 5 days it likely is pseudomonas. Treat appropriately.

Submitted by J. Rothstein.

Reference(s): a good guide for AB tx if suspected osteo; picture


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