Abstract
Case study
An unsuspecting surfer develops sudden burning pain in her right heel while walking through the shallow water back to shore. Over the proceeding half an hour, the pain progressively intensifies until she is struggling to weight-bear. The lifeguard in attendance on the beach encourages her to put her foot into a bucket of hot water.
This is a weever fish spine sting
Our unwitting victim had, as they say in many coastal areas, ‘been weevered’. The weever fish (Fig. 1) is the most venomous of the temperate zone and found in many areas around the Mediterranean Sea, eastern Atlantic Ocean and European coastline. They are small (less than 15 cm), sand-coloured creatures with a grumpy up-turned mouth, and eyes on the top of their head. Their toxic toolkit consists of poisonous spines on the dorsal fin. They hide from prey by burying in the sand (Auerbach, 2013).
The symptoms of a sting include sudden burning pain that peaks at 30 minutes. This usually subsides within 24 hours. The puncture site often shows little bleeding but can appear pale and oedematous. Over 6–12 hours, the wound can become red, ecchymotic and warm. An unlucky few may develop systemic symptoms, including syncope, hypotension and cardiac arrhythmia. Infections are relatively common owing to the depth of the puncture and the ‘dirty’ nature in which the wound usually occurs (usually murky, sandy or muddy water) (Auerbach, 2013).
Most UK beach lifeguards are trained in basic first aid and are likely accustomed to managing weever fish stings. However, lifeguards are not present all the time and most coastal areas are unpatrolled. Treatment consists of immersing the wound in non-scalding hot water to tolerance (45°C) for 30 to 90 minutes or until significant pain relief occurs. The wound should not be soaked in ice water. Removing any obvious spine fragments and basic wound care are important to prevent infection. Simple analgesia and a serving of sympathy never goes amiss. After all, no one wants to sit on a beach with their foot in a bucket while watching friends out surfing! In some situations, prophylactic antibiotics are necessary if the wound is more than minor or the patient is immunocompromised (Auerbach, 2013; eMedicineHealth, 2018).
There are ways to reduce the chances of being ‘weevered’. Take care when entering or exiting the sea, especially at low or spring tides and wear wetsuit boots or other suitable footwear (Irishhealth.com, 2018; NHS, 2018). Shuffling the feet slowly through the sand when walking instead of lifting them is said to help. The vibration and dragging of your feet will hopefully make the fish move out of the way, preventing you from standing on them.