I stepped on something and it stuck in my foot. No big deal, I pulled it out and cleaned the area. Now my foot is red, hot and swollen....what should I do? This scenario happens every day and the swollen, infected part could have been easily avoided with a quick trip to the podiatrist. Puncture wounds are extremely common in the foot, especially in times of warm weather, due to people walking barefoot. Even though they are extremely common, most people do not treat them adequately. Getting proper treatment within 24 hours is important in decreasing the infections that lead to serious complications.
Proper treatment should start with prevention! Do not go barefoot, especially outside and in the garage where loose objects and foot terrors seem to lurk! Keep knives, scissors, and breakables out of the reach of children. Remove nails from boards and dispose of them properly. Always sweep up glass immediately after breaking an object. Keep areas free from trash and debris. Keep up to date on your tetanus vaccination (every 10 years is recommended).
Foreign objects embedded in a puncture wound are extremely common. All kinds of things like toothpicks, glass, small pebbles, needles, nails and even wiry pet hair can become stuck in a puncture wound. Even pieces of your own skin, sock and shoe as well as dirt and foliage can be contaminating a puncture wound. Remember that all puncture wounds are considered dirty wounds because they involve penetration of the skin with a dirty object. Don't assume that a minor wound is clean just because you can't see dirt in it. Don't even try to clean or take large objects out of a serious wound. Go to the ER immediately if you have a large wound, an embedded deep object or the bleeding doesn't stop after 5 minutes! Regardless of the foreign body, anything that remains in a wound can become an abscess and lead to a severe infection.
Treatment of puncture wounds should begin within 24 hours of the wound and start with cleansing of the wound and close monitoring until it is healed. Surgical cleaning with removal of any foreign bodies is often necessary coupled with a week or two of antibiotics, depending on the wound contamination. A recent study recommended that all puncture wounds in the foot should be treated with at least 1 week of oral antibiotics. X-rays may even be needed to evaluate the bone for any involvement. A bonus is that metallic foreign bodies can also be detected by x-ray.
Often foreign bodies can be missed in the emergency room, so proper follow up with your podiatrist is important. Infection is a common complication, so your doctor will monitor your wound closely until it heals. Any changes, swelling, redness or discharge should be reported immediately. In diabetics or patients with poor circulation, a puncture wound can lead to an infection so serious that it leads to an amputation.
Do not delay treatment! Hindsight is always 20/20, but you don't want to be the one wishing they had come into the office when they are in the hospital with a severe infection. Do not play around with puncture wounds, seek medical attention immediately!