Foreign bodies in feet

Re: Foreign bodies in feet

Bob Russell — Tue, 22 Jul 2014 13:33:46 GMT

For crying out loud!

If you dance anticlockwise, then clockwise with your eyes closed you will fall over. It works just as well (and hurts less) if you squint through one eye.

Re: Foreign bodies in feet

katja wagner — Tue, 22 Jul 2014 10:32:51 GMT

well i would like to tell you but it is a big secret which has been passed on over generations and only very special people are allowed to know how it works!

Re: Foreign bodies in feet

Rob Reid — Mon, 21 Jul 2014 18:15:30 GMT

[quote user="Richard Carter"]So to get this clear in my head - do you start dancing in a clockwise or anti-clockwise circle?? If I try both is this a double blinded study?[/quote]

Only if you wear a blindfold and get one of your nurses to do the dance at the same time.

Re: Foreign bodies in feet

Richard Carter — Mon, 21 Jul 2014 17:44:29 GMT

[quote user="katja wagner"]although not without the little woodoo dance we always did[/quote]

So to get this clear in my head - do you start dancing in a clockwise or anti-clockwise circle?? If I try both is this a double blinded study?

Re: Foreign bodies in feet

katja wagner — Mon, 21 Jul 2014 16:54:35 GMT

nothing scientifically proven I am afraid and might be it would have just worked without the "magic paste"although not without the little woodoo dance we always did

Re: Foreign bodies in feet

Martin Atkinson — Mon, 21 Jul 2014 16:47:38 GMT

[quote user="katja wagner"]the other dog was my case which presented with unspecific "unwell,just not right" symptoms and after bloods,x rays and ultrasound scans without any results I was unable to figure out the problem ,owner keen for referal so send off and scan found a FB track via chest,diaphragma and then stuck in abdominal wall trying to for a way out. I would have never found this one.[/quote]That was my point really but a far cry from a non-resolving interdigital fistula.

[quote user="katja wagner"]In austria we used a black ,strong smelling tarry paste on limbs covered with dressing which worked very well to draw FBs out but i have never come across this here and would like to know if there is something similar available on the market?[/quote]See snake oil does work sometimes. I think 'drawing out' is over-simplistic and smacks of old wives tales. The principle is surely just keeping the hole open and the area inflammatory active to allow it to work its way out naturally. Or am I misinterpreting some scientifically proven formula as magic?

Re: Foreign bodies in feet

katja wagner — Mon, 21 Jul 2014 16:27:58 GMT

I remember two cases which were send for MRI scans. One was a dog which was investigated six times for FB on a front leg ,each time without success and limb swell up again once antibitoics stopped FB found via scan and removed at referal centre. the other dog was my case which presented with unspecific "unwell,just not right" symptoms and after bloods,x rays and ultrasound scans without any results I was unable to figure out the problem ,owner keen for referal so send off and scan found a FB track via chest,diaphragma and then stuck in abdominal wall trying to for a way out. I would have never found this one.

In austria we used a black ,strong smelling tarry paste on limbs covered with dressing which worked very well to draw FBs out but i have never come across this here and would like to know if there is something similar available on the market?

katja

Re: Foreign bodies in feet

Martin Atkinson — Mon, 21 Jul 2014 16:04:20 GMT

I make an attempt to milk the grass seed out of the fistula in consult, if I can't find it I give them antibiotics. IME in the vast majority of cases this will work after all you don't know if that is an entry or exit wound and if you find one seed you don't know that was the only one (my record is 6 out of one fistula under GA with crocodile forceps - how did I know that there was none left even after that)? If the fistula persisted I would then GA and go looking but I'd say in 50% of cases I don't find one. This is not surprising given the record distance I had one travel was above the elbow!!

As for nasty places to find them, found one embedded in a testicle once. And on in a parotid salivary duct, given there was no external entry wound and the parotid duct was very inflammed I reckon it worked its way up from the inside.

Incidentally would anyone really pay for an MRI just to find a grass seed unless it was in an unidentified mass in a vital area? Funny how I've managed 39 years without!

Re: Foreign bodies in feet

Rob Davis — Sat, 19 Jul 2014 15:10:31 GMT

Agree with most of the above. I have on occasion flushed a small amount of iodine-based contrast medium into the tract (being careful not to allow any to overflow) and then x-rayed to try to identify the extent and direction of the tract. While it often doesn't help, it is relatively quick and cheap and occasionally comes up trumps!

Re: Foreign bodies in feet

Rob Loxley — Fri, 18 Jul 2014 23:05:24 GMT

Have to say my rule for suspected FBs is not to put on antibiotics until explored - nowt's going to die from the infection from a FB, but it's damned hard to find anything without the infection trail to follow.

Re: Foreign bodies in feet

Busybee — Fri, 18 Jul 2014 21:49:52 GMT

We see a lot around here!

My approach:

-advise 'O' there may well be a fb. Give the option of trying anti-inflamms/antibs, or exploring under sedation/GA - more emphasis put on whichever one I think will work best. If they opt for medical tx first, consider a poultice to try and draw something out a bit more (dependent on case). If they opt for exploration, advise it may take more than one attempt to find the fb.

- if we go for exploration, either initially or after medical tx: sedate/GA, incise and probe (consider more than one site - my colleague eventually pulled a grass seed out of the palmar aspect of a foot when it appeared to be focused completely on the anterior aspect) and flush thoroughly with saline from more than one angle.

- if no fb produced, leave wound open but again, consider a poultice/dressing. We do use anti-inflamms/antibs. Check every 2 days, expecting an improvement every time. If not improving, repeat exploration.

Sometimes, after 2 or 3 explorations, they seem to spontaneously resolve. If persistent, consider CT scan.

My colleague has an ongoing case at the moment, not a grass seed in the foot, but vegetative material in the neck. Has had 2 explorations with us then referred for CT and surgery - currently holding the record at 6 scans and 6, going onto 7 explorative surgeries and they find a bit more every time!

Re: Foreign bodies in feet

Rob Reid — Fri, 18 Jul 2014 17:44:00 GMT

Doesn't really answer the initial question though!

If I don't find anything, I tend to flush these copiously with saline or very dilute pevidene and then leave the wound open. If you're still convinced there's a FB in there then I'd argue for not using anti-biotics in a bid to try and get the FB to point, would still provide analgesia though.

Re: Foreign bodies in feet

Rob Reid — Fri, 18 Jul 2014 17:34:29 GMT

[quote user="Richard Carter"]Can anyone explain the perivulval grass awns in bitches?? Surely if you are being stabbed when you squat, you move away?[/quote]

It's not just bitches - I once removed a grass awn from a Westies prepuce! Aaaayyyyyyeeeeaaazzzzz!

Re: Foreign bodies in feet

Richard Carter — Fri, 18 Jul 2014 17:02:15 GMT

it is the distance these things can travel - starts in foot, erupts near elbow or tracking under the belly skin like some demented mole. Can anyone explain the perivulval grass awns in bitches?? Surely if you are being stabbed when you squat, you move away?