A bulky dressing is applied to the plantar surface to cushion any plantar laceration. For large lacerations on the plantar surface, weight bearing is avoided for at least 5 days. However, infants will naturally step on the injured site. Crutches are too difficult to use in children younger than age 7 years. Therefore, younger children may need to be carried. Elevation of the extremity decreases swelling and infection risk. Sutures are removed in 10 to 14 days.
Antibiotic prophylaxis should be considered in foot lacerations. Infection occurs in 18 9 to 341 percent of foot lacerations. In small lacerations to the dorsum of the foot, antibiotic prophylaxis is unnecessary. Animal bites require coverage against Staphylococcus, Streptococcus, and Pasteurella. Asplenic or immunocompromised patients who sustain a dog bite to the foot should receive coverage against C. canimorsus. Amoxicillin-clavulanate will cover all four organisms. A foot laceration caused from wading in freshwater streams should receive antibiotic prophylaxis for Aeromonas hydrophila (a gram-negative bacillus) with a fluoroquinolone. An Aeromonas infection should be suspected for rapidly developing infections involving foot lacerations. Aeromonas infections occur 8 to 48 h after 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 percent of cases. 10 Compartment syndrome, myonecrosis, and foot amputation can result. Effective antibiotic coverage against Aeromonas includes aminoglycosides, trimethoprim-sulfamethoxazole, and fluoroquinolones. Though fluoroquinolones are routinely used in the adult for A. hydrophila, their use is avoided in children. Open fractures are most commonly infected by S. aureus, so patients should receive a first-generation cephalosporin and an aminoglycoside in the ED. For other lacerations, antistaphylococcal antibiotics are sufficient.
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