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Objectives and questions: Puncture injuries of the pediatric foot can progress to deep soft tissue infections and are associated with significant morbidity. Management of these infections is often challenging and may require complex surgical intervention or reconstructive procedures. While negative pressure wound therapy (NPWT) is widely used in adults, reports of its use as a definitive treatment in pediatric foot infections are rare. This case report aims to evaluate whether surgical debridement combined with NPWT can achieve complete wound healing and satisfactory functional outcomes without reconstructive surgery in a child.

Material and methods: A five-year-old girl sustained a plantar puncture injury after stepping on a rusted nail while wearing a shoe and subsequently developed a severe soft-tissue infection of the foot. Radiographic, ultrasonographic, and magnetic resonance imaging were performed to exclude retained foreign material and to assess any possible bone involvement. Due to significant swelling and clinical signs of infection, the patient was admitted to the hospital and treated with antibiotics for a total of six weeks, along with a dose of tetanus immunoglobulin. Microbiological analysis identified Staphylococcus aureus (MSSA) as the causative organism. Surgical debridement, approximately 2 cm wide, was performed down to the tarsal bones to remove infected and necrotic tissue, including the fibularis brevis tendon and the articular capsule. Postoperatively, negative-pressure wound therapy was applied, with dressing changes performed twice weekly over a one-month period.

Results: The wound showed progressive improvement with healthy granulation tissue formation throughout the treatment period. Complete wound closure was achieved approximately two months after the initial injury. No reconstructive or plastic surgical procedures were required. At the latest follow-up, the patient was pain-free, demonstrated a full range of motion of the ankle and foot, and had returned to full weight-bearing. Loss of active foot eversion was noted due to fibularis brevis involvement, without relevant functional impairment.

Discussion and conclusions: This case demonstrates that NPWT can serve as a definitive treatment for deep pediatric foot infections, avoiding the need for reconstructive surgery. Its successful use in this patient highlights the potential role of NPWT in children, in whom evidence is currently limited, and suggests that it may be a valuable option in selected pediatric orthopaedic cases with extensive soft tissue involvement and good patient compliance.