Diagnosis of foot foreign bodies with ultrasound: a case series from the pediatric emergency department

Aim: Foot foreign body injuries are prevalent among pediatric populations, posing diagnostic and management challenges. X-ray examination is the first choice used by emergency physicians for localization and removal of foreign objects but it has limited value when the foreign body is not radiopaque, leading to missed diagnoses of non-radiopaque foreign bodies, we recommend simultaneous use of point-of-care ultrasound (POCUS) to rule out foreign body in every case especially when history and clinical exam highly suggestive of foreign body. This case series highlights the diagnostic utility of X-ray and POCUS in the emergency department and its sensitivity in detecting radiopaque and as well radiolucent foreign objects. Material and methods: We describe a case series of foot foreign bodies in children, highlighting the clinical characteristics, diagnostic challenges, and utility of POCUS in the pediatric emergency department. Some patients had delayed presentation in the emergency department due to missed diagnosis in the first place. Results: Patient with sharp foreign bodies, such as glass, typically present with more pain and refusal to bear weight, and POCUS was also difficult, as while probing the area they experienced severe pain. Softtissue foreign bodies such as wood, glass and plastic may remain undetected on radiography, but are easily detected by bedside POCUS. Conclusions: This case series underscores the importance of early recognition and utility of POCUS as well as proper exposure X-ray imaging as the first choice for emergency physicians for ruling out foreign bodies in the foot.