Foreign bodies, or what are sometimes called retained foreign bodies, range from wood splinters to glass to shard of metal. The feet are particularly susceptible to puncture wounds and retained foreign bodies. Toothpicks, splinters of wood from the old wood floor or a sliver of glass from that broken light bulb and casserole dishes top the list in my practice. Most retained foreign bodies are superficial and are removed at home with tweezers. I tend to see the deeper and larger foreign bodies such as a large piece of glass that you find while barefoot in the creek.
All foot docs know that finding the retained foreign body is either really simple or really tough. When visualized on x-ray, a piece of metal in the bottom of the foot seems so easy the grab and remove…but not so. Retained foreign bodies reside within a three dimensional series of layers that go beyond just the skin. Retained foreign bodies can be in muscles, fat or tendons. The only foreign bodies that I’ve ever removed from bone are bullet fragments.
There’s another foreign body that really isn’t so foreign. That foreign body is hair. While a long piece of hair is very flexible, a short of hair can become quite rigid. For hair to act as a foreign body, the short, rigid piece of hair slips into the ridges in you skin and slowly begins to puncture the skin. The puncture of the skin is a slow process that progresses with each step. Before long, the hair has punctured both the epidermis and the deeper dermis. Once beneath the dermis, your body recognizes that not-so-foreign body and a foreign material. A low grade infection starts with localized erythema in an attempt to expel the foreign body.
Treatment of hair that has become a foreign body is simple. Usually, the hair doesn’t completely puncture and go beneath the skin. Use a device like a pair of tweezers to extract the piece of hair. If the hair does go beneath the skin, your body doesn’t give up. The site will abscess and, in most cases, your body will expel the hair.
Next time you have that sinking feeling that maybe you stepped on something, make sure to include hair as a part of your differential diagnosis for a retained foreign body.
Jeff
Medical Advisor
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