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Oozing puncture wound on foot

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A minor foot injury did not prompt our patient to seek treatment. The painful swelling that came later, did.


 

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A 49-year-old, unkempt-looking Indian man came into our emergency department in Singapore complaining of increasing right foot swelling and worsening pain that he’d had for a month after having stepped on a fish bone while walking on the beach. Our patient pulled the bone out himself and did not seek immediate medical attention.

Our patient said that he had occasional fever with chills and rigors. His medical history was unremarkable, and there was no history of previous injury or surgery to the right foot. He worked as an “oiler” refueling ships, and said that he did not drink alcohol or smoke.

He was dehydrated, and there were no other sources of infection or sores on his body. Our patient was febrile (38.3°C [100.9°F]), his blood pressure was 112/74 mm Hg, and he was tachycardic at 117 beats per minute.

His right foot was boggy, swollen, and tender with significant crepitus. Brownish discharge was oozing from the sole of his foot (FIGURE 1). There were large infected subcutaneous bullae on the dorsum of his foot (FIGURE 2). We could feel a popliteal pulse in both legs, but could not feel a right dorsalis pedis pulse.

What is your diagnosis?

FIGURE 1
Swollen, dusky foot

The 49-year-old patient stepped on a fish bone while walking on the beach. One month later, his right foot was swollen, dusky, and erythematous. Note the brownish discharge from the puncture wound.

FIGURE 2
Dark bullae

The patient had hemorrhagic dark bullae on the dorsum of his foot, as well as surrounding discoloration

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