Treating a Puncture Wound on the Foot: A Simple Guide for Puncture Wounds

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Puncture wounds occur after stepping on a sharp object.

Treatment for puncture wounds in the foot can vary depending on the extent of infection and the medical history of the patient. Treatment can also differ if you were wearing shoes when you sustained the puncture wound versus if you were barefoot. 

In general, infected puncture wounds are treated with antibiotics, and in some cases surgical incision and drainage. If the puncture wound is deep and an abscess is present, you’ll likely need an incision and drainage procedure of the foot with IV antibiotics to eradicate the infection. 

In this article, you’ll learn about how puncture wounds are treated. 

What Are Examples of Puncture Wound Injuries?

A puncture wound occurs when penetration of the skin and underlying soft tissue occurs from a sharp object. These objects include wood, glass, metal, ceramic, nails, sewing needles, etc. 

When you step on a sharp object like a needle, part of the object may break off, leaving the rest of the needle intact in your foot.

However, if you step on glass, ceramic, or wood fragments, the fragments can break and lead to multiple foreign bodies that get stuck in the foot. 

Who Is at High Risk for Developing a Puncture Wound?

Diabetic patients are at a greater risk of developing an infection secondary to a puncture wound in the foot. This is because many diabetics have neuropathy in their feet. The lack of sensation in their feet increases their chances of stepping on something and being unaware of it. 

Many diabetics may walk on the puncture site and can develop an infection faster. They may also wait longer before being seen by a doctor due to being unaware of the injury. 

This increases the risk of bone infection. Osteomyelitis is more commonly seen in diabetic patients than in nondiabetic patients (1).  

To read more about How to Treat Diabetic Neuropathy in detail, check out this supplemental post.

What Should You Do if You Have a Puncture Wound?

Examine the Puncture Wound Site

If you sustain a puncture wound while barefoot, make sure to immediately identify the location and size of the puncture wound.

Check to see if there is a foreign body embedded in your foot. Examine the surrounding skin to make sure there is only one wound. 

If you are wearing a shoe, make sure to carefully remove your shoe and examine your foot. Make sure to check the bottom of the shoe to determine what the foreign body is. 

Make note of the type of shoes you are wearing so you can notify your doctor. 

Gently Wash Your Foot Using Soap and Water

Using a washcloth, gently wash any visible dirt and debris away from the puncture wound site. Do not scrub the skin too aggressively. This can cause pain. 

Soak in Epsom Salts

Start Epsom salt soaks. This can help cleanse the foot and can also help reduce pain. Avoid soaking the foot in hydrogen peroxide, as this is not optimal for wound healing. 

Apply Antibiotic Cream Onto the Puncture Wound and Keep It Covered

Apply over-the-counter antibiotic cream such as Neosporin onto the puncture wound site, and keep the puncture site covered with a bandage. If there is excessive bleeding, you may need to keep it covered using gauze and Coban. 

Wrapping the foot using Coban can help limit bleeding. You can obtain this on Amazon. Continue wound care daily. 

Stay Off of the Lower Extremity

If you sustain a puncture wound with a foreign body that is embedded in the foot, it’s best to stay off of the lower extremity until you can see your doctor. 

If you have a puncture wound in the forefoot, walk on your heel until you can obtain crutches. 

If you have a puncture wound on your heel, walk on your tip-toes until you can get crutches. 

If you struggle using crutches due to balance issues, you can obtain a knee scooter on Amazon to help you stay off your foot. 

Staying off of your foot is important because walking too much can cause the foreign body to move deeper into the foot. 

Not only that, walking on a puncture wound with an embedded foreign body can be painful.

Elevate the Lower Extremity

It’s normal for a puncture wound site to swell. Make sure you elevate your foot on two pillows while seated and sleeping to help prevent swelling. Elevating the lower extremity can also help relieve pain. 

Take Pain Medication

Puncture wounds can be painful. Over-the-counter pain medications such as Ibuprofen and Tylenol can be helpful to manage pain. You can ice the area of the puncture wound to help reduce pain. 

Ice constricts blood vessels in the area of injury and can help alleviate throbbing pain. 

Pain from puncture wounds can persist anywhere from 2 days to a week or longer. 

When Should You Seek Professional Care?

Minor puncture wounds in the lower extremities can be treated at home. However, some puncture wounds require immediate medical attention. 

Make sure to see your foot doctor or go to the Emergency room if you experience any of these symptoms:

• If the puncture wound becomes infected (redness, heat, pus, red streaking at puncture wound site)
• Persisting pain that has not resolved after two days
• If there is a foreign body that is embedded in the foot
• If you have difficulty walking 
• If the puncture wound site is dirty
• If you were wearing shoes when you sustained the puncture wound
• If you stepped on an infected needle
• If you have not had a tetanus shot in the past 5 years (TdaP, DTaP, and Td vaccines)
• If you develop a fever and feel unwell

How Is a Puncture Injury Diagnosed?

Puncture wounds are diagnosed clinically and with imaging. Your doctor will check your feet to see where exactly the puncture wound has occurred. Your doctor will check to see if there is a retained foreign body in the foot and whether there are any signs of infection in the lower extremity. 

Your doctor will order x-rays of your foot to see if any foreign bodies are embedded in your foot. Metallic fragments are more easily visualized on x-ray, unlike glass and wood. 

X-rays can also rule out gas that occurs from bacteria that produce toxins in the foot. 

If nothing is visible on the x-ray, your doctor may order an ultrasound to see if there is an embedded foreign body in the lower extremity.

If your doctor suspects an abscess or even bone infection, more detailed imaging such as a CT scan and MRI of the foot may be ordered. Both CT scans and MRIs can identify foreign bodies. 

A CT scan may be preferred if the foreign body is metallic and the patient cannot get an MRI.

An MRI on the other hand would show detailed images of the bone and soft tissue, and identify any pus pockets present in the lower extremity. This is important for surgical planning. 

Also, MRI and CT scans can identify bone infections that can occur from puncture wounds. Although the risk of developing a bone infection from a puncture wound is low, it’s best to rule it out. 

Lab markers may be ordered when there is a presence of infection. These labs include a complete blood count (CBC), C-reactive protein, and sedimentation rate (ESR). These markers can be elevated in the presence of an infection.

Wounds greater than 6 hours old with increasing pain and redness are likely infected (2). 

How Are These Wounds Treated?

Antibiotics

Minor puncture wounds can be treated at home by cleansing the puncture site and appropriate wound care. 

However, if the puncture wound is deep, very painful, infected, or has a foreign body that is embedded in the lower extremity, you should go to the Emergency room or see your local foot doctor.

Oral antibiotics, such as cephalosporin and penicillin antibiotics are usually given. These medications treat organisms (Staphylococcus aureus and Streptococcus) that are most commonly seen in puncture wounds (2). 

If you were wearing a shoe when you sustained a puncture wound, there’s a higher likelihood that the puncture site may be infected with Pseudomonas bacteria. 

This bacteria can often be found in the foam lining of certain athletic shoes. In this case, Fluoroquinolone antibiotics may be added to cover this organism. 

Tetanus Shot 

If you haven’t had a tetanus vaccine, you will need a tetanus shot. Being up to date on the tetanus vaccine can help prevent infection. Clostridium tetani are the bacteria that cause tetanus. 

Tetanus can cause severe muscle spasms, seizures, and fever to occur. If you have never had a tetanus shot and the puncture wound site is dirty, you will require a Tetanus-toxoid containing vaccine as well as a tetanus immune globulin.

Check out this table for tetanus guidelines by UpToDate.com.

Surgery 

If you have an infected abscess or a foreign body present in the lower extremity, your doctor may suggest surgery.

Surgery would be done under anesthesia in the operating room.

Your doctor will make an incision to the puncture site and remove the foreign body. In addition, any pus and devitalized tissue will be removed. 

You will need to stay off of your feet in a cast boot or cast for up to a month after surgery depending on the incision site. Diligent wound care will be required after surgery to heal the surgery site. 

Your doctor will provide you with instructions on how to properly take care of the wound after surgery. 

If your doctor suspects a bone infection, he/she will obtain a sample of bone and send it to the lab to confirm there is a bone infection. 

If a bone infection is present, your doctor may recommend IV antibiotics for 6 weeks to treat the bone infection. In rare cases, amputation can occur. 

To read more about bone infections in the foot, check out this supplemental post about Diabetic Foot Osteomyelitis (Bone Infections).

Puncture wounds that occur in the forefoot and midfoot are at the highest risk of developing bone infections. This risk is increased in diabetic patients.

If a foreign body penetrates one of the joints in the lower extremities, the risk for septic arthritis in the joint increases. 

Complications 

How Long Do You Have to Get a Tetanus Shot After a Puncture Wound?

If you have a puncture wound and it has been more than 5 years since you have had a tetanus shot, you should see your doctor within 48 hours to receive an injection. 

If you cannot get a hold of your doctor, you can get a tetanus injection at your local Urgent Care or Emergency Department.

How Long Does It Take for a Puncture Wound to Get Infected?

Infections secondary to puncture wounds can occur 48 hours after the initial injury. Infection can present as redness, swelling, warmth to the puncture site, and pus. 

Can a Puncture Wound Cause Nerve Damage?

Puncture wounds can cause nerve injury and damage to the foot. This is especially true if the foreign body penetrates a specific nerve in the lower extremity, causing it to become injured. Numbness, tingling, and burning pain may be present after the injury. 

Conclusion

In conclusion, lower extremity puncture wounds are a common yet potentially serious healthcare concern, especially in individuals with existing ankle conditions or diabetes. Public health awareness and prompt management can significantly reduce associated complications, such as infections or nerve damage. It is advisable to consult with a healthcare provider or visit a clinic in case of a traumatic injury to the lower extremity or any signs of infection following a puncture wound. 

A foot and ankle surgeon can offer expert advice and treatment options, particularly for severe cases. Over the span of 0-12 months, recovery can vary depending on the severity of the wound, patient’s overall health, and the success of the treatment plan. 

Stay aware of the latest news and information resources on lower extremity and ankle health for timely action and prevention. Remember, when it comes to cut or puncture wounds on the foot, the timely involvement of a qualified physician is crucial in ensuring optimal outcomes.

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References

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2. James Q (2016). Puncture wounds and bites. Tintinalli J.E., & Stapczynski J, & Ma O, & Yealy D.M., & Meckler G.D., & Cline D.M.(Eds.), Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. McGraw Hill. https://accessemergencymedicine.mhmedical.com/content.aspx?bookid=1658&sectionid=109449392
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7. East, J. M., Yeates, C. B., & Robinson, H. P. (2011). The natural history of pedal puncture wounds in diabetics: a cross-sectional survey. BMC surgery, 11(1), 1-9.https://bmcsurg.biomedcentral.com/articles/10.1186/1471-2482-11-27
8. Lavery, L. A., Walker, S. C., Harkless, L. B., & Felder-Johnson, K. (1995). Infected puncture wounds in diabetic and nondiabetic adults. Diabetes Care, 18(12), 1588-1591.https://diabetesjournals.org/care/article/18/12/1588/18765/Infected-Puncture-Wounds-in-Diabetic-and
9. Patzakis, M. J., Wilkins, J. E. A. N. E. T. T. E., Brien, W. W., & Carter, V. S. (1989). Wound site as a predictor of complications following deep nail punctures to the foot. Western Journal of Medicine, 150(5), 545.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1026657/
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