Locks and Crocs: Keep on your Socks

Hair splinters are the result of hair fragments penetrating into non-hair-bearing areas of skin. Once considered a rare occupational hazard, it is likely that hair splinters are underreported.^1-3 Hair splinters can be asymptomatic or quite painful. If left untreated, they may lead to complications, such as pilonidal sinus and foreign body granuloma.^3–5 Hair splinters have most commonly been reported in barbers, hairdressers, sheep shearers, and pet owners.^1,3-5

Hair fragments are most commonly seen penetrating between fingers,¹ toes,⁵ or in bottoms of feet.^1-4 Most patients with pedal involvement reported wearing open-toed shoes near loose hair. Removal of the hair is typically curative, but hair splinters may recur if preventative measures, such as frequent cleaning of hands and feet, removal of any loose hair, and wearing gloves and closed-toed shoes, are not implemented.^3-5

We report a case of a 44-year-old man who developed recurrent hair splinters in both feet (Figure 1) for almost a year. His hair splinters exclusively occurred on the heel and never between the toes. The hair splinters were novel to him, and the patient was at a loss to explain the phenomenon until his wife linked onset to the purchase of a new pair of fleece-lined “Cozy Crocs” (Figure 2) worn daily, without socks, to walk his dog. The sparing of the toes is not uncommon in case reports.⁴ In this case, it may be due to the posterior portion of the shoe being open, thus having a greater surface area for the hair to fall onto before being forced through the skin.

Figure 1: Photo of foot with hair splinter prior to removal

Figure 2: Photo of “Cozy Crocs” footwear with hair imbedded in lining

The patient treated the painful episodes by removing the offending hairs with tweezers. When the footwear that was suspected as the cause was discarded, the hair splinters resolved without recurrence. We postulate that hairs trapped in the lining of the shoes worked into the skin via direct contact, due to frictional force during walking.

We report this case of recurrent hair splinters in an adult male so that clinicians might consider hair fragments captured in fur-lined footwear as a potential etiology for recurrent hair splinters.

The authors have no conflicts of interest to report and no sources of funding to report.

1. Greig AI. Hair Splinter. Br Med J. 1962;2(5312):1127.

2. Watts WD. POINTS FROM LETTERS: “Hair Splinter.” Br Med J. 1962;2(5316):1406.

3. Mozena J, Jones CP. When Patients Present With Hair Slivers In The Foot. Podiatry Today. 2016;29(7). Accessed May 2, 2020. https://www.podiatrytoday.com/when-patients-present-hair-slivers-foot

4. Naimer S. Polarized Dermoscopy Facilitates Diagnosis and Treatment of Plantar Pseudohirsutism. Asia Pac Fam Med. 2019;18(1). Accessed May 2, 2020. https://dev.jurnal.ugm.ac.id/v3/APFMJ/article/view/77

5. Nowak DA, Sladden C. Barber’s sinus between the toes of a female hairdresser. Cutis. 2019;104(3):E32-E33.