Dr. Vincent Giacalone
Podiatric Medicine & Surgery
466 Hook Rd., Suite 24D, Emerson, NJ 07630
What is a Puncture Wound?
Puncture wounds and cuts are not the same. A puncture wound is a small entry hole caused by stepping on a sharp object such as a nail. In contrast, a cut is an open wound that doesn’t produce a “hole” but rather a long tear in the skin. Puncture wounds require different treatment from cuts because these small holes in the skin can disguise serious injury and harbor bacteria.
Puncture wounds are common in the foot, especially in warm weather when people are typically barefoot. But even though they occur frequently, puncture wounds of the foot are among the most inadequately treated conditions and if not properly treated, infection or other complications can develop.
Receiving 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 of puncture wounds could be prevented if the patient seeks professional treatment quickly.
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 offenders. In addition, pieces of your own skin, sock, and shoe can be forced into the wound during a puncture, as well as dirt and debris from the object. By their nature, all puncture wounds are dirty wounds because they involve penetration of an object that isn’t sterile.
Regardless of what the foreign body is, anything that remains in the wound increases your chances of developing other problems, either in the near future or down the road.
Severity of Wounds
There are different ways of determining the severity of a puncture wound. Depth of the wound is one way to evaluate how severe the wound is. The deeper the puncture, the greater the likelihood of a 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 as opposed to a sewing needle, the more dirt and debris are dragged into the wound, which may increase the chance of infection. Another factor which can determine wound severity is whether you were wearing socks and shoes or were barefoot. Particles of socks and shoes can get trapped in a puncture wound.
Treatment of Puncture Wounds
The key to proper treatment is this; 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 Dr. Giacalone for a thorough cleaning and careful follow-up. The sooner you do this, the better, within 24 hours after injury, if possible.
Dr. Giacalone is trained to properly care for these injuries and will make sure your wound is properly cleaned and no foreign body remains. He may anesthetize 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. To treat or prevent infection, antibiotics may be prescribed.
Once you return home, be sure to carefully follow the instructions 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 2 to 5 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 proper treatment can play a crucial role in preventing them.
What should you do if you have a puncture wound?
- Seek treatment right away.
- Get a tetanus shot if needed (usually every 5 years).
- See a Dr. Giacalone within 24 hours.
Follow the instructions:
– Keep your dressing dry.
– Keep weight off of the injured foot.
– Finish all your antibiotics (if prescribed).
– Take your temperature regularly.
– Watch for signs of infection (pain, redness, swelling, fever).
Call Dr. Giacalone if you have any of these signs
Dr. Giacalone has been trained specifically and extensively in the diagnosis and surgical treatment of foot disorders. Dr. Giacalone has been board certified by The American Board of Podiatric Orthopedics and The American Board of Podiatric Surgery since 1995 and is a Fellow of the American College of Foot and Ankle Surgeons. He recently practiced at the Hospital for Joint Diseases in New York City. Dr. Giacalone performs surgery at Hackensack University Medical Center (HUMC) in Hackensack, HUMC @ Pascack Valley in Westwood and Surgicare Surgical Center in Oradell.