What is a Puncture Wound?

Puncture wounds are not the same as cuts. It has a small entry hole caused by a pointed object, such as a nail, needle, piece of glass, thumbtack, or thorn that you have stepped on. In contrast, a cut is an open wound that produces a long tear in the skin. Puncture wounds require different treatment from cuts, since these small holes in the skin can disguise serious injury.

These wounds are common in the foot, especially because Caribbean people love to walk barefoot in the house and outside. But even though they occur frequently, puncture wounds of the foot are often inadequately treated. If not properly treated, infection or other complications can develop.

Foreign Bodies in Puncture Wounds

A variety of foreign bodies can become embedded in a puncture wound. Nails, glass, toothpicks, sewing needles, insulin needles, and corals/ seashells are some common ones. In addition, pieces of your own skin, sock and shoe can be forced into the wound during a puncture, along with dirt and debris from the object. All puncture wounds are dirty wounds because they involve penetration of an object that is not sterile. Anything that remains in the wound increases your chance of developing other problems, either in the near future or later.

Severity of Wounds

There are different ways of determining the severity of a puncture wound. Depth of the wound is one way to evaluate it. The deeper the puncture, the more likely it is that complications, such as infection, will develop. Many patients cannot judge how far their puncture extends into the foot. Therefore, if you have stepped on something, and the skin was penetrated, seek treatment as soon as possible. Home remedies are not always a successful option.

The type, and cleanliness of the penetrating object,  also determine the severity of the wound. Larger or longer objects can penetrate deeper into the tissues, possibly causing more damage. The dirtier an object, such as a rusty nail, the more dirt and debris are dragged into the wound, increasing the chance of infection.

Another thing that can determine severity is if you were wearing socks and shoes, particles from which, can get trapped in the wound.

Treatment

A puncture wound must be cleaned properly and monitored throughout the healing process to avoid complications. A tetanus shot may be required. Even if you have gone to an emergency room for immediate treatment of your puncture wound, see a doctor or podiatrist for another cleaning and careful follow-up. The sooner you do this after the injury, the better.

The doctor or podiatrist will make sure the wound is properly cleaned, and no foreign body remains. They will thoroughly clean inside and outside the wound, and monitor your progress. In some cases, x-rays may be ordered to determine whether something remains in the wound, or if bone damage has occurred. Antibiotics may be prescribed if necessary.

Avoiding Complications

Follow instructions for care:

• Sometimes a minor skin infection evolves into osteomyelitis (a bone or joint infection), so you should look for these signs:
  • A minor skin infection may develop two to five days after injury.
  • The signs of a minor infection that show up around the wound include soreness, redness and possibly drainage, swelling and warmth. You may also develop a fever.
  • If these signs have not improved, or if they reappear in 10 to 14 days, a serious infection in the joint or bone may have developed.

• Other complications that may arise from inadequate treatment  include painful scarring in the affected area, or a hard cyst where the foreign body has remained in it.

Your Responsibilities for Self-Protection

These cannot be overemphasised:

• See a doctor or podiatrist within 24 hours.
• Get a tetanus shot if needed (usually every 10 years).
• Follow your medical practitioner’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, and check a professional, if these signs of infection appear (pain, redness, swelling, warmth, fever).

The KEY take away is to NOT walk barefooted, and check inside, along with the base of your footwear for foreign objects. Ensure footwear has a thicker sole and is cushioned, because objects easily penetrate flat shoes. This is particularly important for patients with diabetes; however, Everyone should check their feet daily.

 

Your feet mirror your general health . . . cherish them!