Many Nicaraguans walk barefoot, which seems impossible to me, but I see this all the time. The pathways, the beach, and the dirt roads are definitely not foot-friendly for Gringos like me. Nicaraguan soles must be like leather.
Over the last two days I was asked to assess two Americans with foot injuries.
A middle-aged man was stung by a sting ray as he was walking in the surf. He felt severe pain and pulled out the stinger from the side of his foot. His fingers started to tingle from the venom and he dropped the stinger. He described the pain as the worst he ever experienced. The puncture wound at the side of his foot was surrounded by a black area about 2 cm by 1 cm. I did an Internet search on sting ray wounds and venom and learned that for foot injuries the most serious common complication is if the stinger penetrates the bone which can lead to osteomyelitis (bone infection) or if the stinger breaks off and leaves a foreign body which invariably gets infected. The worst aspect of the acute injury is the severe pain, which is ameliorated by intense heat. I checked with the fellow the next day and he was feeling great, so infectious complications are not a concern.
The second person was a high school senior who stepped on something sharp on the beach. He had a very painful, hot, swollen area below his third toe and when he moved the toe, the pain was intense, which implied the tendons or muscles that controlled the toe were inflamed. I treated him with ciprofloxin, anti-inflammatory medications, hot soaks, and elevation. I checked on him earlier today and he is improved with less tenderness and swelling. All good.
Over the last two days I was asked to assess two Americans with foot injuries.
A middle-aged man was stung by a sting ray as he was walking in the surf. He felt severe pain and pulled out the stinger from the side of his foot. His fingers started to tingle from the venom and he dropped the stinger. He described the pain as the worst he ever experienced. The puncture wound at the side of his foot was surrounded by a black area about 2 cm by 1 cm. I did an Internet search on sting ray wounds and venom and learned that for foot injuries the most serious common complication is if the stinger penetrates the bone which can lead to osteomyelitis (bone infection) or if the stinger breaks off and leaves a foreign body which invariably gets infected. The worst aspect of the acute injury is the severe pain, which is ameliorated by intense heat. I checked with the fellow the next day and he was feeling great, so infectious complications are not a concern.
The second person was a high school senior who stepped on something sharp on the beach. He had a very painful, hot, swollen area below his third toe and when he moved the toe, the pain was intense, which implied the tendons or muscles that controlled the toe were inflamed. I treated him with ciprofloxin, anti-inflammatory medications, hot soaks, and elevation. I checked on him earlier today and he is improved with less tenderness and swelling. All good.
Snowy Egrets must have tough, no slip toes
because they land on the beach and rocks with no problem. 
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