E.H. is a Diabetic with loss of feeling in his feet. Technically, we call this "LOPS" (Loss of Protective Sensation). He stepped on a toothpick, and it broke off up inside his foot. I always tell my diabetic patients NOT to go barefoot. Unfortunately, he didn't become my patient until his Family Physician admitted him to the hospital with a wholloping infection, and called me in.
The infection was so severe that it caused Gangrene to develop on the bottom of the big toe.
No one knew about the toothpick until I was in the process of amputating the toe, and discovered it way up inside the tissues on the bottom of the big toe.