Foreign body - distal leg

Case contributed by Maulik S Patel


History of penetrating injury by wood splinter - anterior distal-most of the right leg (ankle region) 20 days ago. Complaining of persistent local pain and swelling.

Patient Data

Age: 10 years
Gender: Male

Soft tissue swelling on the anterior aspect of the distal leg and ankle region. No radiopaque soft tissue foreign body.

Presence of Sever's phenomena (sclerosis of calcaneal apophysis). No fracture/dislocation/periosteal reaction.


An effusion in intact tibialis anterior tendon sheath. Normal tendon echopattern.

Multiple linear echogenic foci with or without acoustic shadow; in subcutaneous plane of the distal third of the anterior leg - clinically area of swelling - foreign bodies.

The largest foreign body is about 40 mm long; lying superficial and parallel to the tibialis anterior tendon in the distal leg. 

A smaller linear foreign body (10 mm long lying deep and lateral to largest foreign body).

A few smaller (1-3 mm) foreign bodies in the local subcutaneous collection measuring about 40 x 20 x 5 mm. All foreign bodies located cranial to skin entry wound.

No foreign body in the tendon sheath. No ankle effusion. No erosion of the adjacent tibial cortex.

Case Discussion

Findings of multiple subcutaneous tissue foreign bodies in the anterior aspect of distal leg region due to fragmentation of the foreign body. There is associated tibialis anterior tenosynovitis and local subcutaneous small collection without periosteal reaction in the adjacent tibial cortex.

Migration and fragmentation should be kept in mind while looking for a wood splinter like foreign bodies.

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