Physical Examination

The physical examination determines the location, length, depth, and shape of the wound. Any wound on the weight-bearing surface is noted, because the wound care plan should consider avoiding weight bearing. As with all lacerations, the distal nerve function, motor function, and vascular integrity (pallor, capillary refill) should be checked. A foreign body is sought on general examination as well as during sterile inspection of the laceration just prior to wound closure. When possible, the wound is explored using a dry field. The loose thin skin over the dorsum of the foot allows for adequate visual, digital, and instrument exploration for tendon lacerations, as well as for foreign-body discovery. The dense tissue of the plantar surface of the foot severely limits wound visualization and exploration. The risk of creating new or further injury limits the exploration of wounds to the sole of the foot, especially at weight-bearing sites. The exception to this general policy is if a retained foreign body is suspected, such as an infected puncture wound presenting 48 h after the initial injury.

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