By Al Kline DPM 

Introduction 

 

 

Foreign body punctures in the foot are very common. Unfortunately, in the emergency setting, they are often mistreated and can lead to progressive soft tissue infection, cellulitis and deep abscesses. Up to 15% of all puncture wounds can lead to an established infection, even with initial antibiotic treatments.

 

Foreign bodies that remain in the foot and do not lead to infection, often form into inclusion cysts. These cysts are tightly encapsulated and may at a later time require surgical removal. Some foreign bodies can remain in the more superficial layers of tissue and form punctuate keratotic lesions.

 

In this case , a small hair penetration is presented with initial punctuate keratosis.  This has often been confused for a ‘corn’ or ‘wart’.  There are few cases reported concerning hair penetration from human or animal hair in the literature.  I have highlighted such as case in this report. 

 

 

 

Presentation 

A 76 year old female presents to our office on consultation with a chief complaint of “corn” to the bottom of the left foot.  She states that she may have “stepped on something about 6 weeks ago”.  The patient is diabetic and hypertensive.  She has no allergies and is taking Lipitor and Insulin for diabetes.  There is no surrounding cellulitis, but she is experiencing pain along the ‘corn’.  She has animals including 2 dogs. 

 

 

 

Clinically, she presents with a 6mm region of hyperkeratosis along the plantar sulcus of the first interspace.  It is interesting that on intial inspection, to the untrained eye a differential diagnosis of verrucae plantaris or simple keratosis could be made.  Upon sharp debridement and putting digital pressure along the region, a small abscess is noticed just as we de-roof the epidermal layers of skin.   A small amount of purulence is expressed.  At this point, a suspected foreign body abscess is noted. 

 

 

On deeper debridement, a small hair-like structure is found and removed. The area was cleansed with normal saline and the patient was placed on Keflex for 10 days.  Pathology report was sent which revealed a small ‘hair-like structure’ measureing .5x.1x.1 cm.  No further treatment was necessary. 

 

 

 

Discussion 

This is an unusual case of foreign body hair penetration to the bottom of  the foot.    This patient had animals that lived with her in the house, so it’s probable that a small, black dog hair penetrated her foot and formed a small abscess.  It is not too uncommon to have a patient presented to your office with misdiagnosis of possible corn or wart.  In this case, a suspected corn or wart was actually a foreign body hair abscess. 

 

 

 

© Al Kline DPM, 2006

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