Toothpick injury simulating a pigmented villonodular synovialitis

Injuries to the foot caused by foreign bodies are a frequent cause of local wounds and infections. In most cases, removal of the debris is easy and no comprehensive surgical care is needed.This case report is about a patient who stepped on a toothpick 10 years ago. The toothpick penetrated the intermetatarsal region I/II of the patient's right foot without any harm to bone or tendon. Assuming total removal of the toothpick only a partial removal was performed. Eight years after the injury a painless swelling occurred for the first time. The tumor was removed surgically. The histologic workup showed a pigmented villonodular synovitis. In the subsequent year swelling occurred again. Under the impression of recurrent pigmented villonodular synovitis a surgical revision was performed. Surprisingly, an almost completely preserved toothpick surrounded by a distinct reaction of a foreign body granuloma was found.In conclusion, foreign-body injuries, as easy as they might seem, need a careful diagnostic workup and sufficient therapy. With injuries documented in medical history, the possibility of a retained foreign body should be considered.