Overview of Puncture Wounds
Dr. John Goodner DPM
Puncture wound injuries are common work place injuries for adults and playground injuries in children. The most common mechanism of injury is stepping on a sharp object, nail or stick, penetrating the foot through the sole of a shoe, sock, or directly due to walking barefoot. Early medical attention is critical, approximately 10% of patients will develop soft tissue infections and 2% will develop infection of the bone. Clinical signs can often present weeks to months after initial puncture injury, so proper treatment and wound care should not be neglected even if the foot appears not to be infected initiallly. Co-morbidities, such as Diabetes Mellitus and other immune system suppressing conditions, increase the risk of spreading infection without visible clinical signs and symptoms until a much later stage of infection is present.
When should I be concerned and seek medical attention?
- The foot is painful, swollen and tender
- A wound can be visualized
- A sinus tract can be seen where the sharp object initially penetrated the foot
- Diffuse skin redness surrounding the wound, foot and/or ascending up the leg
- Swollen or palpable lymph nodes behind the the knee or in the groin
- If Fever, Nausea, Vomiting, Chills, or Shortness of Breath become present
- An X-Ray and/or MRI may be necessary to evaluate the extent of the infection in the soft tissues and bone.
- Tetanus booster is advised, especially, if the patient is not up to date on their vaccination schedule.
- Wound debridement and antibiotic infused irrigation is advised for most wounds
- Oral or IV antibiotics will often be given in accordance with depth of infection, level of contamination, wound cultures taken and patient health condition
- The foreign material can become enveloped in the soft tissue and a chronic inclusion cyst may form, requiring removal if painful or if it causes a recurrent infection.
Intraop Pics of Excsion of Inclusion Cyst from Prior Puncture Wound