Author: Mike Nova

Dr. Jeffrey Hurless still remembers the young patient who showed up for a podiatry appointment complaining about a large blister on the bottom of his big toe. The sore spot was red, swollen, and painful—and the boy and his mother had no idea what had caused it. As the patient reclined in an exam chair, Hurless began to deroof the blister, which means removing its top layer of skin. Then the surprise hit. Literally.

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“I’m working on this boy’s foot pretty close to my face, probably a foot away, and I’m gently going a little deeper, and then a little deeper,” recalls Hurless, a podiatrist and foot and ankle surgeon at Neuhaus Foot & Ankle in Nashville. “All of a sudden, a plastic toothpick literally shot out of his foot under such pressure that it went over my right shoulder and hit the wall behind me.”

Everyone in the exam room erupted into cheers: Good riddance to the interloper! At first, the boy was stumped by the toothpick’s presence. Then he remembered: he had stepped on something a few days ago, but didn’t know what it was.

Hurless lives for moments like this: They make the podiatrist’s daily schedule interesting, a welcome distraction from the more routine foot warts and bunions. (Ask him about the time he borrowed a hammer from his hospital’s janitor to remove a massive nail that had pierced a patient’s boot and gone into their foot bone.) “It’s a common issue that we see, and actually, I quite enjoy it,” he says. “Every foreign object is unique, and it’s very rewarding to get them out—both for the patient and myself.”

We asked podiatrists which foreign objects are most likely to get stuck in your foot—and which cases are permanently lodged in their memories.

The weirdest things podiatrists see

At Northern Illinois Foot and Ankle Specialists, Dr. Patrick McEneaney encounters more foreign bodies than people would expect. He’s removed fragments of fine china plates, fishing hooks, knitting and sewing needles, metal shavings, injection needles, and much more from patients’ feet. Other podiatrists at his practice report removing bullet fragments, a golf tee, a chicken drumstick, earrings, porcupine quills, gravel, and even a dead mouse. (A small one, McEneaney clarifies, that had burrowed into an open wound on the patient’s foot.)

Recently, McEneaney treated a patient who was suffering from mysterious foot pain; an ultrasound and MRI revealed inflammation but no objects. After three rounds of antibiotics, McEneaney decided to do exploratory surgery and ended up spotting a piece of hair out of the corner of his eye. “It was this long, kind of bristly hair, so I saved it and I said to the patient, ‘What hair is this?’ He goes, ‘That’s a skunk.’” It turned out the man was an animal catcher with the local animal control, and his unit had been getting frequent calls to assist with skunks.

Read More: Put Your Shoes Back On. Here’s the Problem With Going Barefoot

Dr. Julie Schottenstein, a podiatrist who runs the Schottenstein Center in South Florida, sees patients with foreign bodies in their feet on a weekly basis. In Florida, people are “barefoot all the time,” she points out, and there are countless threats lurking on the sand and in the ocean. She’s removed at least seven sea urchin spines, for example, which can be venomous and cause localized soft tissue death, which means she often needs to take the patient into the operating room to clean all the bacteria out of their feet, disinfect the wound, and remove dead or contaminated tissue. That helps prevent infection, but she still starts them on an antibiotic to ensure they recover smoothly.

Palm fronds are a common culprit, too. “There’s a spike that comes out of several of the palms here that can impale the foot,” says Schottenstein, who calls herself “the foreign body queen.” “It’s very sharp, and it can go deep into the foot.” They can also be quite large: “You’re like, how are you walking around with this in your foot?”

It might sound more innocuous, but “hair splinters”—from humans or animals—can be equally painful. Picture a coarse dog hair capable of piercing the skin. Schottenstein often asks patients: “Do you have an animal?” If their answer is yes, she takes it a step further: What kind? Wire-haired dogs, like schnauzers and terriers, are especially likely to land their owners in the podiatrists’ office. Their fur is similar to tiny needles with “sharp, tapered ends that really hurt,” she says.

Foreign-object removal 101

The first rule of foreign objects: If you think you have something in your foot, don’t attempt to remove it at home. Digging around by yourself is never the answer. “People try to do their own ‘bathroom surgery’ and handle it themselves, but then it starts getting red and hot and swollen, and [the object] gets deeper,” McEneaney says. “They develop a pocket of pus, and sometimes those need to be drained surgically.”

Instead, schedule an appointment with a podiatrist—and don’t be embarrassed. Foot doctors have seen it all. Hurless usually starts appointments by taking a thorough history, which can help rule out a number of possible reasons why someone’s feet hurt. Then he does an exam, often using a magnifying glass to identify a tiny break in the skin that could have served as an entrance point. After that, he takes an X-ray, which will often (but not always) provide a sense of the object’s size and location. From there, he typically uses a scalpel blade, which allows him to gently shave down layers of skin and isolate the object, followed by a tweezers-like fine forcep to grab the foreign body and pull it out.

Read More: How to Deal With Sweaty Feet

About 10% of the time, Hurless detects signs of an infection and puts the patient on an oral antibiotic. Generally, though, most people recover fine at home with Epsom salt soaks, a daily bandage change, and applying antibiotic ointment. “It’s like you would treat any other wound while it heals,” he says.

Not all foreign objects need to be removed. McEneaney recalls taking an X-ray of an older man’s ankle and saying: “Hey, you’ve got a BB in your foot.” The patient was well aware: “That’s from where my brother shot me when I was 8,” which was more than 50 years prior. Hurless, similarly, once had a patient who’d had a piece of a drill bit in her foot for 20 years. “If a foreign object is deep and it’s not bothering somebody, I say don’t mess with it,” he says.

The two groups at highest risk

Kids often complain of foot pain—but have no memory of what they might have stepped on while dashing around the yard. Young children, in particular, aren’t always able to communicate their pain well. “I have times when kids are limping and the parents are like, ‘I think they hurt their knee or their ankle,’” McEneaney says. “No, they stepped on something.”

Schottenstein once treated an 18-month-old who had a chicken bone stuck in his foot; a construction worker had discarded it, and the parents didn’t realize it had ended up inside their toddler’s foot.

Read More: The Health Benefits of Wearing Shoes in the House

People with diabetes are also at increased risk, because they can develop diabetic peripheral neuropathy, which means their nerves are damaged from elevated blood sugar levels. They might not be able to feel anything on or in their feet. McEneaney recalls a patient who showed up with—much to the man’s surprise—a 2.5-inch nail that had penetrated his heel bone. “The only reason he came in was because his wife was yelling at him because there was blood on the white carpet in the living room,” McEneaney says. The patient didn’t seek treatment for two weeks, by which point he had developed an infection.

Hurless, meanwhile, once had a patient who gave himself insulin injections and then dropped the needles onto his bathroom carpet. “He came in one day with an issue, so I told my medical assistant to take an X-ray of his foot,” he says. “He had at least 20 of those needles in there.” The man’s feet were so numb, he never had a clue.

How to keep your feet safe

There’s an easy way to protect yourself from most foreign objects: Wear shoes, especially outside. Even if it’s nice out. “Don’t walk around barefoot,” McEneaney stresses. You also shouldn’t wear sandals when you’re doing lawn work, because they don’t provide enough coverage, which means you could end up with a splinter or some other painful intruder.

Keep your floors as tidy as possible, and if you break a glass in your house, go overboard cleaning. People usually manage to collect all the big pieces, Hurless says, but miss some of the tiny shards, which a podiatrist will later discover because it’s wedged into their foot. “People do a cursory vacuum, and they sweep real quick, but you’ve gotta go really far away,” he says. “When glass shatters, it goes a long distance.”

It’s also helpful to get in the habit of doing regular foot inspections. Clean your feet every time you come back in after spending time outside, Schottenstein advises, and at night, sit on the edge of your bed with a flashlight and hand mirror and look over the soles of your feet closely. “The answer is surveillance,” she says. “It should be a habit, just like brushing your teeth.”