See subject. (I just saw “standard operating procedure” is a nice double meaning.)
It’s been a long time since self-debridement and certainly since Mom-debridement. Is the poking around with a flame “sterilized” needle still recommended?
The reason I am now more careful is I have diabetes; no neuropathy–man, can I feel the damn thing and it hurts and I’m limping–but still the effects of the disease are a crazy long time for lacerations or punctures of any size to heal.
I’m sure the little sucker is close to surface of the ball of my foot.
More damage if I do get it out–not a given–by the poking around?
If so, me and the podiatrist have a date.
Given the diabetes, don’t dig around. Urgent care or the podiatrist. Check your tetanus vaccination status while you’re at it. Don’t forget Monday is a federal holiday.
While diabetes is a magnified risk factor in foot injuries because of the reduced tissue perfusion (reducing oxygen and nutrients to tissues), generally speaking you don’t want to “dig around” in a wound searching for a splinter or piece of debris that you can’t find and extract with tweezers, both because of the additional damage to dermal and connective tissues, and because you are increasing the chance of a serious infection. The best thing to do is irrigate the wound with water or saline followed by antiseptic, cover and pad it as best possible (difficult on a bearing surface like the ball of the foot but you can create a ‘donut’ pad with some fabric to relieve pressure on the affected area), and have a medical professional examine the wound and perform extraction of the foreign material. An urgent care or physician will update your tetanus vaccine which is important especially with foot injuries because Clostridium tetani endospores are ever-present in soil and dirt tracked inside, and tetanus is a horrible disease to suffer.
I wouldn’t mess with it unless you can see or feel an exposed end and can cleanly pull it out with some tweezers. The bottom of a foot can be an awkward place to attempt this.
Find matches (the hardest part). Find needle (second hardest). Hoist foot on knee. Light match, transfer match to non dominant hand, position needle point and tippy portion in flame. Hold in check: a) misgivings about the whole damn enterprise; b) misgivings if this really does “sterilize” anything; c) misgivings because now maybe that the needle is burning hot it will hurt even more; d) misgivings because you never find the damn thing and wind up letting it get devoured or slip out or whatever the hell happens to splinters after they stop hurting and you forgot about them; e) misgivings because as you begin to begin the surgury you’re still debating which hurts more, the current situation or whatever it is you will now inflict on yourself.
Sterilizing metal probes by holding them in a Bunsen burner flame until they are red hot is a legitimate technique in the lab, but it does not matter even if you use a standard autoclave—“self surgery” is a bad idea. If a splinter is poking out, just pull it out with tweezers.
We physicians have a saying: Do home surgery on yourself and you have a foolish potential corpse for a patient.
Now I’ve been that fool a few times, but at least I’m an experienced fool. And we’re all worm food eventually. But still, the smart money is on letting someone else do it.
I doubt I have matches in the house. But there are some lighters around (charcoal starting and emergency candles) and a gas range.
To be perfectly honest, I’d probably take a stab (Ha!) at digging it out myself as OP is suggesting. But I’m not diabetic and don’t really understand all the consequences so best to stick with the advice of others: seek professional help.
Uses sterilized equipment, topical antiseptics, good lighting and magnification as necessary, knowledge of anatomy to avoid doing ancillary damage, topical anesthetic if it is necessary to do any actual incision, careful technique to avoid driving the foreign matter deeper into the body, post-removal assessment to assure that tissue is healthy and no sign of infection, tetanus booster. That sort of thing.
He probably wasn’t thrilled either. That’s a pretty low level use of skills there, for most podiatrists I’ve worked with and referred to. Unless a lot of grinding of deformed nail is needed, most of them job such work out to a nurse they train and supervise for that.
I was surprised to discover a few years ago that there is an entire cottage industry of nurses who essentially do nothing but foot and nail care. It makes sense because of how much of an epidemic that diabetes has become, and regular preventative care is a lot cheaper and probably more effective than waiting until a problem is bad enough to go to a podiatrist for treatment but it never even occurred to me that foot care would be a specialty in nursing.
A lot of my older patients rely on our foot care nurse and are ultra careful to always be grateful and never upset her! Many are not limber enough to treat their own toenails anymore, and others have such horrific nails they need bolt cutters for them, which is of course not allowed for them.
I restrict my podiatric surgical work to mainly ripping out ingrown toenails with a small clamp. It helps the patient and helps me deal with frustration.
Hi Leo - You’re still not reading like a proofreader.
A pre-flamed match as in your OP’s title is very hard to light. A pre-flamed needle as in your OP’s body and the quoted bit just above is too hot to comfortably stick into your skin.
Details matter to me and we are very short on them.
If this is a very superficial object clearly visualized then personally even with diabetes trying to pull it out with a home sterilized tweezers, even using the sterilized needle to tickle the end up or to gently remove some of the dead skin above it to reveal enough to grab on to, would be fine. Irrigate copiously afterwards and get seen if any subsequent signs of infection (redness warmth tenderness pus …). A small superficial sliver of glass from something that broke in your kitchen floor say is not a concern for tetanus (albeit being up to date is always advised!)
If more deeply embedded then it needs a pro.
It may in that case also be worthwhile to get an X ray after removal; would routinely be so in my world. Glass is actually radio opaque and a shard more deeply embedded might have a part that broke off inside.
Personal experience story:
A kid came in to my office years back. While at the lake house she ran into a plate glass patio door shattering it. Went to local ED where they pulled a small bit of glass out from under her eyebrow. No X ray done. In to see me because now home they had noticed a little lump there.
Ordered an X ray and there a hint of something under the skin but the radiologist couldn’t say how deep it went. CT ordered. There was a shard that had found its way through the potential space between the globe of the eye and the bony orbit stopping only when it hit the bony back of the orbit!
Ophthalmology very carefully backed it out (in the operating room of course). No damage done. Lucky kid!
Foot care nurses are a subset of home health nurses who receive special training on nail management, wound care, proper shoe and sock fitting, corn and callous removal, and a host of similar foot-related issues. They also check for possible problems and maladies that have the potential to snowball into much more significant issues if left unaddressed. Considering the population of people suffering from diabetes, Alzheimer’s, dementia, and physical mobility limitations the demand for foot care nurses is significant.
I believe our own @Johnny_L.A 's wife is a foot care nurse. Our local foot-care nurses have more people requesting their services than they have the ability to care for and while I can’t speak to their fees or what their income is, the ones I’ve spoken to love doing what they do and the freedom it gives them and none of them have any desire to return to working in a “traditional” nursing role in a hospital or clinic.
Yeah, that all makes sense; I just hadn’t thought about it prior to a few years ago because except for trauma- and athletic-related injuries I’ve never spent any amount of time consulting a doctor about my feet and wasn’t really aware of the specific maladies and treatments that would require a specialized workforce of trained nurses.
I’ve since learned about that as well as different kinds of infections and injuries that can occur to hands and feet as part of wilderness medical training where the comprise a large proportion of traumatic injuries in the backcountry. As a result, I am much more careful about protecting extremities and treating any injuries on hands and feet including scratches and minor blisters.
