An Unusual Foreign Body Causing Symptoms After 40 Years: A Case Report
Diana Marinha CRUZ, José M. SEARA and Daniel GONÇALVES
This is a clinical case of a 71-year-old woman who went to an urgent consultation for pain in the distal region of the sole of the right foot; she denied trauma or effort. On physical examination, there was an induration, which was painful on palpation.Ultrasound and X-ray evaluation showed a foreign body (FB) associated with a granuloma in the distal end of the metallic linear image, measuring 6.5 cm, projected at the base of the second metatarsal. Sent to traumatology, a partial extraction of the FB was performed. It showed extensive corrosion, causing a metallosis reaction. The patient kept a part of the FB with about 3 cm, with adequate healing, and she recovered completely.When asked about the discovery, she remembered an episode of trauma with a rod from an umbrella, more than 40 years ago, which was supposedly removed by a healer. She was unaware that that piece of the object remained.This is a rare case of a 71-year-old woman with a metallic FB retained in the foot for an extended period after the trauma, without symptoms. Despite surgical removal, a residual fragment remained; nevertheless, the patient achieved full recovery without apparent complications. Although a fragment of an FB remained on her foot, this did not prevent the patient from fully recovering and continuing to walk, without complaints, during two years of follow-up. However, it is unpredictable if any other symptoms may develop in the future.This case highlights the importance of thorough clinical history-taking and consideration of remote traumatic events in the differential diagnosis of unexplained pain in the foot or other anatomical regions in elderly patients. However, unusual FBs can also appear in other age groups, particularly in patients of other nationalities, which is increasingly common with the emigration of patients whose countries have very different social, cultural, and health conditions.This case underscores the extraordinary capacity of the human body to tolerate retained foreign materials for prolonged periods. Clinicians should maintain some suspicion for FBs in patients presenting with atypical localized pain, even when the inciting event may have occurred decades earlier.
