[Top: The bandaged foot of Ms Jacqueline Huang and the Magnetic Resonance Imaging scan of her foot after the operation, which showed the spot where the twig was located.]

By Ho Lian-Yi

FOR more than a month, Mrs Jacqueline Huang suffered intense pain in her left foot, unaware that a twig from a tree was embedded inside.

After the wound began festering and caused parts of her foot to turn black, with two pus-filled bumps, she managed to find it and pull it out herself.

She had accidentally kicked a branch while on a Sunday morning stroll with her husband and daughter at Lower Peirce Reservoir at 9am on 24 Aug.

A twig fragment, which her daughter, who is in her 20s, said was 'as long as a finger', had lodged inside the 46-year-old tutor's foot, undetected by doctors.

'We didn't know there was a twig inside (the wound),' said her manager husband, Mr Huang, 47.

Mrs Huang remembered shouting in pain when her slipper-clad foot kicked some twigs that were sticking out unnoticed on the wooden pathway.

She pulled the branch away from her left foot and found a bleeding wound between her second and third toes.

Her family took the limping woman to a clinic. She said the doctor, after dressing her injury, directed her to Tan Tock Seng Hospital's accident and emergency department, where an X-ray was taken.

Mrs Huang said the doctor told her it showed no foreign objects in the foot.

She said he took off her bandages and told her to go home.

The wound hurt but she said: 'What came next was worse.'

The day after, her foot began to swell.

She went to a GP every week to get her wounds dressed. She was also given antibiotics. But her swelling didn't go away.

Her left foot ballooned to 'twice the size' of her other foot. It also sent up sharp pains that made Mrs Huang feel like her heart was being 'pulled'.

During this time, she continued visiting her students, taking taxis everywhere she went, despite the agony.

'I couldn't walk normally, I could only take very small steps. I was dragging my foot,' she said.

She wondered if something was stuck inside her foot, and asked various doctors if they could refer her to a specialist.

Saw many doctors

Her daughter said her mum went to clinics in Bishan, Bukit Timah and Bukit Batok.

But the doctors all told her the same thing. There's nothing stuck in her foot. That's what the X-ray had shown.

Mrs Huang said she didn't take further action as she trusted what the doctors told her.

But her daughter decided to go online to look for a specialist herself. She found Dr Pham Quoc-Ahh, from the Singapore Footcare Centre.

By then, Mrs Huang's skin was blackening between two bumps the size of 5-cent coins that had appeared on the top of her foot.

She had already taken five courses of antibiotics.

She said Dr Pham suspected there may be something in the foot and referred her to another specialist.

On 29 Sep, the day she was supposed to visit the specialist, Mrs Huang decided to squeeze one of the nodules that grew on top of her foot.

'It looked like a zit. I thought I could press the pus out,' she said.

She found a black object lodged inside, and she tugged it out.

To her horror, she found it was a twig fragment, about 3.5cm long.

She called her husband and daughter about her discovery.

'I was so shocked. I couldn't believe it,' said Mr Huang, who rushed home with his daughter to take his wife to Tan Tock Seng Hospital.

When they arrived, Mr Huang said he wanted his wife to be checked and operated on immediately, but the hospital said she had to be admitted first.

Unable to agree, the family took Mrs Huang to Mount Alvernia Hospital, where another X-ray was taken and she was operated on. The operation to remove contaminated flesh took about 90minutes.

She was discharged two days later, on 1 Oct. She has been staying at home since.

Her wound remains open.

Mrs Huang said the doctor has to monitor the status before he can stitch it up. Her next appointment with Mount Alvernia is on 16 Oct.

She said the doctor told her she was responding well to treatment.

The medical cost so far is more than $6,000, she said.

But it wasn't about the money.

'It was the pain,' she said.

TTSH: Hard to detect wood in X-rays

TAN Tock Seng hospital said Mrs Jacqueline Huang visited its Emergency Department with a referral letter indicating that she had a cut on her foot by a wooden splinter.

'We conducted an X-ray to check for foreign objects, fracture and dislocation. As the X-ray did not show presence of any material, her wound was cleaned and dressed,' it said.

The hospital's Divisional Chair of Ambulatory Medicine and Diagnostic Radiology, Associate Professor Seow, said: 'A month later when Mrs Huang returned to our emergency department with a swollen foot, we learnt that she had a wooden splinter which was not detected by the initial X-ray.

'The detection of wood or plastic in X-rays is often limited as both materials can be hidden by overlying bones in our bodies. The rate of detection of these materials is poor especially in cases of minor injuries.

'It would have been easier for the doctor to treat Mrs Huang if she had described in detail how her injury happened. We would have also performed a minor surgery to remove the splinter if she had come back to us when her foot condition worsened.'

It is important that patients go back to the same doctor or hospital when their condition deteriorates. This will allow doctors who are aware of their history to recommend the subsequent treatment.

This story was first published in The New Paper on Oct 11, 2008.