What Is a
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
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.
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
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 wound.
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 necessary.
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.
Information provided by The American College of Foot and Ankle Surgeons
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