Puncture Wounds of the Foot

What Is a Puncture Wound?

A puncture wound is a hole made in the skin by an object upon which you step, for example, a nail. Puncture wounds require evaluation and treatment as small holes in the skin can disguise serious injury.

How Is a Puncture Wound Different Than a Cut?

A cut is an open wound in the skin that generally has the appearance of a long tear. Puncture wounds have the potential for germs and bacteria to be put deeper into the body by the object that punctured the skin.

Why Is It Important to Treat Puncture Wounds?

Chicago Foot Puncture Treatment
Left & Middle: The pencil that was found embedded in this patient's
foot. You can see an outline of the lead on the x-ray.
Right: Part of a sewing needle that was embedded in a patient's foot
who had diabetes and neuropathy. This was later removed surgically.
Puncture wounds are common in the foot, especially in warm weather when people go barefoot. Puncture wounds occur frequently in the foot but are often inadequately treated. That's a big concern, because if not properly treated, infection or other complications can develop.

Getting proper treatment within the first 24 hours is important with puncture wounds because they carry the danger of embedding the piercing object (foreign body) under the skin. Research shows that complications of puncture wounds could be prevented if the patient seeks professional treatment right away.

Foreign Bodies in Puncture Wounds

A variety of foreign bodies can become embedded in a puncture wound. The common offenders are nails, glass, toothpicks, dog hair, sewing needles, insulin needles, and seashells. In addition, pieces of your own skin, shoe and/or sock can be forced into the wound during the puncture as well. Dirt and debris that were on the object prior to it entering your skin can be contaminants as well.

As none of this is sterile, puncture wounds are considered contaminated or 'dirty' wounds. This means that there is likely foreign material in the wound as well as bacteria and other germs.

Regardless of what the foreign body is, anything that remains in the wound increases your chances of developing other problems, either in the near future or down the road.

Severity of Wounds

There are different ways of determining the severity of a puncture wound. One way to evaluate puncture wound severity is the depth of the wound. The deeper the puncture wound, the greater likelihood that an infection will develop. Many patients can’t judge how far their puncture wound extends into the foot. For this reason, it is important to seek treatment as soon as possible.

A second way of determining the severity of the puncture wound is the type and ‘cleanliness’ of the penetrating object. Larger and longer objects can penetrate deeper into the tissues of the foot with the potential of causing more damage. The more contaminated or ‘dirtier’ the object (for example, a rusty nail compared to a sewing needle), the more dirt and debris are dragged into the wound, which may increase the chance of infection.

Does It Matter if I Was Wearing Socks or Shoes When This Occurred?

Yes. It does matter what was or was not on your feet when the foreign object entered your foot. If you we wearing socks or shoes, portions of the sock and/or the shoe could have entered the wound with the foreign body.

Treatment of Puncture Wounds

A puncture wound must be cleaned properly and monitored throughout the healing process to avoid complications such as injection. Your tetanus status should be evaluated as you may need a tetanus booster. Even if you have gone to an emergency room for immediate treatment of your puncture wound, you should still see a Weil Foot & Ankle Surgeon for evaluation and follow up of this condition.

Avoiding Infection

Infection is a common complication of puncture wounds that can lead to serious consequences. A minor skin infection can evolve into a bone or joint infection, which is serious and can require hospitalization to adequately treat. A minor skin infection typically develops in 2 to 5 days after injury. The area around the puncture wound will be red, hot, swollen and tender to the touch. There may be drainage coming from the puncture wound that is clear, straw colored or cloudy. You may develop a fever or feel like you have the flu. If this is the case, it is very important that you seek evaluation and treatment immediately.

If the signs above do not resolve or resolve and then re-appear at 10–14 days after the injury, a serious infection the bones or joint around the puncture wound may have developed.

Other complications that may arise from inadequate treatment of puncture wounds include painful scarring in the area of the wound or a hard cyst where the foreign body has remained in the wound.

Although the complications of puncture wounds can be quite serious, early proper treatment can play a crucial role in preventing them.

Puncture Wounds: What You Should Do

  • Seek treatment immediately
  • Get a tetanus shot if needed
  • See your Weil Foot and Ankle Surgeon within 24 hours
  • Follow your doctor's instructions:
    • Keep your dressing dry
    • Keep weight off of the injured foot
    • Finish all your antibiotics (if prescribed)
    • Take your temperature regularly
    • Watch for signs of infection (pain, redness, swelling, (fever)
    • Call your doctor if you have any of these signs