Osteitis of the fourth metatarsal caused by a date palm thorn in a child: why the dorsum of the foot is the most commonly injured site.

Abstract

The palms are frequent in the region of eastern Morocco. An insidious onset of a lytic lesion in the base of the fourth metatarsal caused by a date palm thorn in a 20-year-old patient is presented. An untreated embedded thorn can cause late complications, including periostitis or osteomyelitis. In most cases, removal of the foreign body is easy, and no surgical care is needed. If detected, these injuries can be treated without complications. In children, however, the diagnosis can be very easily missed, especially if the child has aphasia and deafness, which was present in our patient. These can influence communication between the child and family, such that the patient is unable to inform the family about what object pricked him (e.g., date palm thorn, toothpick, insect) and is unable to tell the family that the foreign object remains embedded. This major communication issue between the child and family can result in potentially avoidable complications such as osteitis. No other issues were present in our patient that could have caused a delay in diagnosis, such as fear of punishment or fear of medical treatment. We present a case of date palm thorn-induced periostitis of the base of the fourth metatarsal. Surgical exploration revealed a 2.5-cm palm tree thorn embedded in granulation tissue, forming an abscess. The lesion was successfully treated by curettage of the lesion and removal of the thorn embedded in the periosteum of the metatarsal base. The purpose of the present report was to explain the mechanism of this rare entity and the frequency of this lesion on the dorsal aspect of the foot rather than on the plantar. Despite the absence of a definite history of trauma, organic foreign material should be in the differential diagnosis of a lytic lesion of the bone, especially in patients who have a problem with deafness or aphasia.