If the shoe fits, wear it

The search for foreign bodies is a common indication for obtaining radiographs in children. Foreign bodies are objects lying partially or wholly within the body that originated in the external environment. Some foreign bodies are radiopaque on x-ray, which can aid in their detection and retrieval. They may be ingested, inserted into a body cavity, or deposited into the body by a traumatic or iatrogenic injury. Most soft tissue foreign bodies are involuntary, resulting from an accident. Some of the most commonly reported soft-tissue foreign bodies are objects that can be easily stepped on such as glass, metal, splinters from wood, or, in one very interesting case, a pencil.

The phrase “watch your step” became very true in the case of a young boy who accidentally stepped on a pencil at school. An x-ray was obtained in order to precisely determine the depth of the pencil within the foot to help rule out associated injury to the foot, as well as to help plan for its removal. In most instances, when a patient comes to have a foot x-ray obtained, the patient’s shoes and socks are removed at the time of examination to aid in evaluation. However, in this case, it was decided for both the ease and quickness of diagnosis that the shoe would be left on in performing the x-ray. The phrase, “if the shoe fits, wear it” took on a whole new meaning. X-ray in this case not only helped to categorize the injury, determine the exact location of both the pencil and its lead within the patient’s foot aiding in its removal, but it also helped to provide an additional “diagnosis” of the patient’s popular brand of shoe. The shoe itself became a highlight instantly recognized by many of its fans as the Converse Chuck Taylor, proving that an x-ray can, in fact, see right through you and your shoe!

Dr. Virginia “Jenna” Brown, author; Glenn Miñano, BFA, editor; Meredith Towbin, copyeditor.