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Puncture Wounds

What Is a Puncture Wound?

Puncture wounds are not the same as cuts. A puncture wound has a
small entry hole caused by a pointed object, such as a nail that you’ve
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
because these small holes in the skin can disguise serious injury.

Puncture wounds are common in the foot, especially in warm weather
when people go barefoot. 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.

Proper treatment within the first 24 hours is especially important
with puncture wounds because they carry the danger of embedding the
piercing object (foreign body) under the skin. Research shows that
complications can 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. Nails, glass,
toothpicks, sewing needles, insulin needles, and 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 isn’t 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’ve
stepped on something and the skin was penetrated, seek treatment as soon
as possible.

The type and the “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 wound severity is if you were
wearing socks and shoes, particles of which can get trapped in the

A puncture wound must be cleaned properly and monitored throughout the healing process to avoid complications.

Even if you have gone to an emergency room for immediate treatment of
your puncture wound, see a foot and ankle surgeon for a thorough
cleaning and careful follow-up. The sooner you do this, the better:
within 24 hours after injury, if possible.

The surgeon will make sure the wound is properly cleaned and no
foreign body remains. He or she may numb the area, 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

Avoiding Complications
Follow the foot and ankle
surgeon’s instructions for care of the wound to prevent complications
(see “Puncture Wounds: What You Should Do”).

Infection is a common complication of puncture wounds that can lead
to serious consequences. Sometimes a minor skin infection evolves into a
bone or joint infection, so you should be aware of signs to look for. A
minor skin infection may develop in 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 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 and proper treatment can play a crucial role in preventing them.


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