Glass in wound?

I trod on a broken pyrex dish two weeks ago. I had the would glued by a novice nurse (I'm in a remote rural location), but a week later went back and another nurse removed the glue and steristripped it instead. The wound is open but is healing well without any sign of infection. It is painless if I don't put pressure on it but if I do there is sharp localised pain. Can I be sure that there is no trace of remaining glass? The first nurse who treated me was not competent, but I don't want to have to go back to the hospital if it is clearly unnecessary.

I would be very grateful for your opinion!

RESPONSE

Hi,

It would certainly be a lot easier for me to tell if there was broken glass in your foot if I could actually examine you, but since that is not possible, perhaps I can draw some conclusions based on how your foot feels and somewhat by the picture you have supplies.

It is now two weeks down the road and you have to ask yourself if you are in as much pain now as you were say ten days ago, whenever you placed your foot on the ground.

If your pain is only from the wound itself with no broken glass inside, then it would seem to me that your foot would be hurting a lot less now then ten days ago as the wound is healing.

If your foot is just as painful now as it was ten days ago that would suggest to me the possibility that there is a foreign body in your foot and as long as the glass is there you will continue to have pain.

The other consideration would be whether or not you are developing an infection. Hard to tell from your picture, but if a small area is getting more red, swollen and perhaps there is even pus coming out, that would suggestive of infection and the real possibility that there is still a piece of glass in your foot.

You do not mention if either nurse actually probed the area looking for glass. In most instances, the glass is usually very close to the surface and one can feel the "scratching" feeling that occurs when a stainless steel surgical instrument comes in contact with glass.

If you have still have doubts and you feel like there still may be glass in your foot, an ultrasound of the area can be very effective in revealing a piece of glass as opposed to an x-ray which is usually not reliable for observing foreign bodies.

Of course I was not present when you sustained your injury, but I am not sure I agree with the treatment that was rendered.

If the cut was very deep, I probably would have put sutures in your foot, which would have required anesthesia, which would then have allowed me to explore the wound better for glass. The reason I would have used sutures as opposed to glue or steri strips is that the skin on the bottom of the foot is under a lot of tension and with just glue or steri strips, the wound is very likely to re-open which sounds like what might have happened in your case.

A deep wound on the bottom of the foot is very prone to scarring, because of the tension on the skin, and the scar becomes permanent (and painful).

If the wound was superficial, I probably would have used steri strips instead of glue, simply because if there was still glass in your foot, the glue is basically sealing the foreign body into your foot. More importantly perhaps, is the fact that I might have suggested you use crutches for ten to 14 days to keep pressure off the wound so that is could heal without excessive pressure on the wound and therefore reduce the chance of scarring.

You can allow a little more time to pass and see if the pain persists. If the pain persists as the wound continues to improve, I would be more inclined to believe there may still be glass in the foot. But as I said earlier, you should consider an ultrasound it that is available in your local medical facility.

Marc Mitnick DPM
DISCLAIMER