A Family Doctor's Tale - PIN IN THE FOOT

DOC I HAVE A PIN IN THE FOOT

This memorable case was a 8 year boy who was brought by the mother to see me because of pain and swelling in his right foot for 2 weeks.
The mother gave a history of the boy jumping on his bed which had small head pins left by his younger sister. 
The boy claimed one of the pin entered his right foot and caused pain in his foot. 
So the mother brought him to a nearby clinic where the young doctor examined his foot and told the mother there may be just a slight infection of his foot. 
He was given some antibiotic and painkiller and an antibiotic cream to apply to the sole of his foot. 

After 5 days the foot became more swollen and painful and the boy was brought to the same doctor again . He was given an injection and an another antibiotic.

After 2 weeks when the swelling of the foot did go down and remains red and painful she was recommended by a friend to bring the child to consult me.

The first thing after I heard the history of a possible pin entering his right foot was to examine the foot carefully. There was indeed a red painful swelling of  the dorsum or the top surface of his foot. 
The second thing that I did was to send him for an X-ray of his right foot.
As suspected the urgent x-ray showed the presence of a pin stuck in his foot in the flesh between the 3rd and 4th toes.

I had to do an urgent surgery to remove the pin. 
Luckily the boy was quite brave and although he cries a bit he knew it was for his own good. 
In an operation that lasted almost 1 hour I had to search for the pin guided by the x-ray and finally retrieved a small rusty pin which was surrounded by fibrous tissues from his foot.
The mother was so relieved to see the pin.
She said she was praying so hard for me to find the pin. 

As the mother did not know whether the boy was given a tetanus toxoid injection to prevent lockjaw in his 2nd visit to the doctor, I had to call the doctor to ask whether he had given the tetanus injection. 
He was shocked to hear that the boy had a rusty pin in his foot for 2 weeks. He said that he gave the boy only an antibiotic injection and not the tetanus toxoid injection which was to prevent lockjaw. 

Lockjaw( A Simple Guide to Tetanus) was a dangerous condition where a rusty nail or metal can cause the tetanus bacteria to grow in the foot resulting in the contraction of muscles including the the heart muscle and then death.

I gave the boy the tetanus toxoid injection and hoped that he will not get tetanus. 

Only once in my work as a family doctor, I have seen a lockjaw patient who had to be sent to hospital where her breathing stopped and had to be resuscitated back to life.

After another x-ray showed the pin was no longer in the foot, I gave him some antibiotics, painkiller and reviewed him the next day.

Happily he was well and he was given an antibiotic cream to apply to his surgery wound. 
After the stitches were removed and the pain and swelling was gone, I was satisfied that the boy was going to be all right.

Any body who has a possibility of a metal foreign body in his flesh should be sent for an x-ray. 
The x-ray can detect any metal in the body easily and knowledge of this can prevent any tragic consequences to the patient.

It was a lesson to all new young general practitioners.