Foreign body migration along a tendon sheath in the lower extremity: a case report and literature review.

Retained foreign bodies unintentionally migrating within the body can result in substantial morbidity1,2 and even mortality; for example, Kirschner-wire migration via blood vessels can cause cardiac damage and death3. More commonly, a penetrating foreign body in the foot, particularly a wooden object, can lead to cellulitis, osteomyelitis, or an apparent “pseudotumor.”4-9 However, foreign bodies in the foot do not appear to migrate far, in contrast to those in the upper extremity, which can migrate along some distance10-12. We report a case of a toothpick penetrating a child's foot and migrating a sufficient distance to be undetectable with conventional imaging techniques. While appropriate imaging technology is available, technology alone may fail to locate foreign bodies, as we describe in the following case report. Thus, one must consider the local anatomy to identify potential migration routes of the retained foreign body. The patient's family was informed that data concerning the case would be submitted for publication, and they consented. A seven-year-old girl was seen in the emergency room at Children's Hospital of Eastern Ontario after she stepped barefoot on a toothpick hidden in the thick carpet at her home. The girl's aunt immediately removed a large piece of an obviously broken toothpick that was extruding from the girl's foot. The remaining, broken end of the toothpick was thought to still be embedded in the girl's foot; however, the family did not seek immediate medical attention as the girl was still able to walk, despite discomfort in the medial aspect of the heel. Overnight, she developed redness and swelling at the entrance site of the toothpick, and she was brought to the hospital emergency room the following morning. On general examination, the girl maintained the left hip and knee in a …