If there is a foreign body in the bony structures or joint, refer to orthopedics. Don't attempt blind probes looking for retained foreign bodies 6. Children presenting after 24 hours usually have an infection. Rule out a foreign body Start on anti Staph oral antibiotic. If symptoms persist after 5-7 days, suspect osteomyelitis.
Patients frequently have pain on the dorsum of the foot as well as around puncture site.
Weight bearing may be refused. Usually the patient in't ill appearing and there is no drainage around the puncture site. Plain xray may not demonstrate bony lesion and may need to do a bone scan. ESR and WBC are often normal. If there is bone infection, start an anti-Pseudomonas drug such as tobramycin or ticarcillin.