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Cut my foot in the lake - soak it in something?

 

   


2wheels

Jul 5, 09 10:51

Post #1 of 14 (5371 views)
Cut my foot in the lake - soak it in something? Quote | Reply

Did a race this morning and punctured the bottom of my foot, it's not big or deep, but it was in nasty old lake water. Should I soak it or treat it in some way to keep the science projects out? Thanks.


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jackmott

Jul 5, 09 10:59

Post #2 of 14 (5364 views)
Re: Cut my foot in the lake - soak it in something? [2wheels] [In reply to] Quote | Reply

cut off the leg, just below the knee

then get an aero prosthetic


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gamebofh

Jul 5, 09 11:05

Post #3 of 14 (5360 views)
Re: Cut my foot in the lake - soak it in something? [jackmott] [In reply to] Quote | Reply

then get an robotic aero prosthetic

Fixed it for you. If you're going all the way, go all the way. ;)

-Jot



gamebofh

Jul 5, 09 11:07

Post #4 of 14 (5358 views)
Re: Cut my foot in the lake - soak it in something? [2wheels] [In reply to] Quote | Reply

Clean the wound with a good antieptic/anesthetic. Neosporin and a good bandage.

Keep it clean and covered.

If you haven't gotten a tetanus shot recently, schedule that for tomorrow with
your Dr.

-Jot


2wheels

Jul 5, 09 11:19

Post #5 of 14 (5352 views)
Re: Cut my foot in the lake - soak it in something? [jackmott] [In reply to] Quote | Reply

In Reply To:
cut off the leg, just below the knee

then get an aero prosthetic
Should the prosthetic be dimpled? And carbon fiber I assume? Thanks.


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rroof

Jul 5, 09 11:25

Post #6 of 14 (5345 views)
Re: Cut my foot in the lake - soak it in something? [2wheels] [In reply to] Quote | Reply

I can take care of that for ya' ;)

Good to get a tetanus toxoid booster if you are not up to date. You can soak in warm water and Epsom Salts (MgSO4) to help "draw" out anything. I really like dilute betadine (povidone iodine solution) as well. A simple adhesive strip and abx ointment then should suffice. Foot puncture wounds frequently get infected (and pretty nasty at that), so prophylactic oral abx are not entirely out of the question, depending on what it looks like.
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Fatigue is biochemical, not biomechanical.
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kaolelo

Jul 5, 09 13:13

Post #7 of 14 (5310 views)
Re: Cut my foot in the lake - soak it in something? [rroof] [In reply to] Quote | Reply

very good idea, update your tetanus. i don't necessary agree about prophylactic antibiotics, because generally they are not recommended, except in specific circumstances. but definitely, keep a close eye, because there can be some nasty organisms in fresh water, including staph aureus, pseudomonas, etc.


shumphries

Jul 5, 09 15:52

Post #8 of 14 (5261 views)
Re: Cut my foot in the lake - soak it in something? [2wheels] [In reply to] Quote | Reply

I had a similar puncture not too long ago. Just doused it once or twice a day in isopropyl alcohol, which was really all I had. No idea if that was good or bad, but it is still attached.


ndenezzo

Jul 5, 09 16:07

Post #9 of 14 (5251 views)
Re: Cut my foot in the lake - soak it in something? [gamebofh] [In reply to] Quote | Reply

In Reply To:
Clean the wound with a good antieptic/anesthetic. Neosporin and a good bandage.

Keep it clean and covered.

If you haven't gotten a tetanus shot recently, schedule that for tomorrow with
your Dr.

-Jot
Good advice, but pass on the Neosporin. When I had a crash a couple months ago I found out in the ER that most of the medical community is starting to go anti-neosporin. I guess it causes quite a few allergic reactions, and it sounds like the cons outweigh the pros. I was told to use bacitracin, which is similar to neosporin, but without the ingredients that cause problems. Just thought, I'd pass that along.


rroof

Jul 5, 09 16:24

Post #10 of 14 (5239 views)
Re: Cut my foot in the lake - soak it in something? [ndenezzo] [In reply to] Quote | Reply

Actually, not that many people are allergic to "neosporin". If you want the magic ingredients, they are polymyxin B, neomycin sulfate and bacitracin zinc. Since the bacitracin is probably what is actually "working", no real reason to sensitize yourself to the sulfate (the likely irritant).

Really, the 'new' hot topical agent is Bactroban (mupirocin) since many strains of MRSA are sensitive to it.
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD


portland79

Jul 5, 09 16:31

Post #11 of 14 (5230 views)
Re: Cut my foot in the lake - soak it in something? [rroof] [In reply to] Quote | Reply

I have one in my house allergic to Neosporin, too... BF sliced his shin on vacation 2 weeks ago, got stitches, and wound up back at the doc due to a rx to Neosporin. Who knew you could be allergic? Switching to just bacitracin did the trick...


kitkat

Jul 5, 09 17:09

Post #12 of 14 (5201 views)
Re: Cut my foot in the lake - soak it in something? [2wheels] [In reply to] Quote | Reply

Yep, x2 rroof advice. Be sure to make it in for a tetanus booster if you haven't had one >5yrs. Whatever you stepped on, get the booster pronto if you
haven't had one recently.

As for Neosporin ointment, not too many people show allergic reactions to this med, but if you have one you can try the bacitracin/bactroban which are Rx'd by
your MD. If no probs, then give the N ointment a go. By now you probably have soaked it and cleaned it well with soap/H20.

My advice to you at this point, is to watch your foot, it will get red and slightly swell a little bit, your own body's defenses at work here. If the swelling should
increase, pain increase, nasty pus-like discharge from the puncture site get into your MD asap or if the redness starts to travel up your leg...not good.

N~


Nate Pearson

Jul 5, 09 17:25

Post #13 of 14 (5186 views)
Re: Cut my foot in the lake - soak it in something? [2wheels] [In reply to] Quote | Reply

ahh! http://www.conradstoltz.com/

Go down a post or two and read the saga.

If it gets red or puffy at ALL go to the Dr. and get some anti-biotics.

Conrad was in the next lane at the pool yesterday and he had to get out because the wrap on his foot wouldn't stay. I bet his season is just about shot. He is lucky that he didn't loose his foot.
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KLG

Jul 5, 09 23:07

Post #14 of 14 (5141 views)
Re: Cut my foot in the lake - soak it in something? [2wheels] [In reply to] Quote | Reply

Unknowingly, Jack hinted at the answer but no one has bitten.

So, aside from the aero proshetic:

In the freshwater plantar puncture wound the feared organism is Aeromonas hydrophia.

Pseudomonas is the concern when the wound occurs through athletic shoes. (~25% of such wounds)

Staph would probably be the most commonly grown.
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From Tintinalli (5th) Emergency Medicine: Antibiotic prophylaxis should be considered in foot lacerations - infection occurs in 18% (Baker Am J Dis Child 144:87, 1990) to 34% (Joffe, Pediatrics 87:900, 1991). (this is all wounds - not water based)

A foot laceration caused by wading in freshwater streams should receive antibiotic prophylaxis for A. hydrophilia with a flouroquinolone.
An Aeromonas infection should be suspected for rapidly developing infections involoving foot lacerations. ~Occurs 8 to 48 hours post inoculation and are rapidly progressive. There is a tendency for deeper structures to become involved: fascia, tendon, muscle, bone or joint involvement occurs in 39% of cases (Semel, Aeromonas hyrophilia water associated traumatic wound infections. J. Trauma 30:324 1990). Compartment syndrome, myonecrosis and foot amputation can result.

Tintinalli on closure of foot lacerations - delayed presentation of foot wounds (beyond ~3hours) should not have primary closure but should have delayed primary closure at 96hours while on anti-staph antibiotic - someone has already provided the link to this photo essay/lesson.

Tintinalli on plantar puncture wounds: No proven benefit to routine prophylatic antimicrobial therapy in the management of clean, nonplantar puncture wounds. Puncture wounds in patients with PVD, DM or other immunocompromised condition are assoc with increased incidence of infection.
Plantar puncture wounds, especially those in high risk patients, those located in the forefoot, or those through athletic shoes should be treated with antibiotics (Pennycock, Puncture wounds of the foot:Can infectious complications be avoided? J R Soc Med 87:581, 1994).
A puncture wound should be irrigated at low pressure ~0.5 psi (not high pressure for fear of displacing foreign matter or dissemination of bacteria deeper into surrounding tissue. "Coring" of the wound is controversial.
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The "take home" message:
A freshwater wound is considered dirty.
A freshwater wound, be it a laceration or puncture, should (read standard of care) have prophylaxis with a flouroquinolone (eg. cipro or levaquin (not in peds))
Foot lacerations that are older than 3 hours should have delayed closure at 96hrs.
Topical antibiotics (x, y, or z) play no role in the treatment of a plantar puncture wound.
Saltwater wounds are "dirty" as well but the bacteria of concern are different.

Kevin

   
 
 
 



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