Late Presentation of a Retained Stingray Spine in the Plantar Medial Hindfoot

Stingray Envenomation: Consequences of an Embedded Spine

Rays and skates are fish with flattened, pancake-shaped bodies that frequent shallow water, where they often lie hidden under the sand. Some of the batoid species are characterized by a stinger with serrated edges, which is covered by a tegument made up of specialized cells that secrete toxins and enzymes with proteolytic activity. Stingray injuries to humans are common in warm coastal regions. In this report, we present a case of an injury due to the insertion of a barb from a Pacific cownose ray, Rhinoptera steindachneri. We assess the tissue complications due to the retention of the spine in the foot, the subsequent infection that caused tissue necrosis, and the reconstructive surgery performed. Based on previous experience, we highly recommend performing diagnostic procedures such as soft tissue radiographs and MRI to ensure the absence of the barb within the wound and thereby avoid further complications. Current textbook treatment is based on limited scientific studies, case reports, and successful clinical treatment of many victims.

A New Endoscopic Approach to Remove a Retained Stingray Barb

Stingray injuries usually happen when a person steps into one, resulting in the attack of the fish introducing a sting into the feet or leg in a defensive manner, causing significant pain and inflammation due to the venom. Retained stingray barb occurs in a low percentage of these accidents and may be difficult to diagnose, for this reason, it is always recommended to use imaging studies. In this case report, we present a 42-year-old man who presented to the orthopedic consult one week after a stingray injury with the diagnosis of retained stingray barb. The aim of this case report is to present a new surgical approach for stingray barb removal with a minimally invasive technique using arthroscopic equipment using the stingray barb entry site as the port to introduce the endoscopic tools. 

Stingray-Induced Tarsal Tunnel Syndrome

This case report involves a 17-year-old male referred for electrodiagnostic (EDX) evaluation with symptoms of tarsal tunnel syndrome after being stung by a stingray. EDX testing revealed moderate axonal injury localized to the tarsal tunnel. Subsequent exploratory surgery removed a stingray barb from the tarsal tunnel. The patient's symptoms nearly completely resolved at five weeks postoperative follow-up. EDX evaluation of this patient with delayed recovery proved to be a valuable component of management.