By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

NAIL WOUND THROUGH SNEAKERS CAN LEAD TO SERIOUS INFECTION

Question: Last week while I was working in my basement woodworking shop, I stepped on a nail and received a deep wound right through my sneakers. It almost felt like it touched a bone. I pulled the nail out and it bled a little. I tried to squeeze it to make it bleed more because I’ve been told that would help clean the wound out as the blood would bring impurities to the surface. It feels much better now. Is there anything else I should do to prevent an infection?

Answer: It is good that you are concerned about treatment for your puncture wound. Before I give you specific advice about further care, let me impart some general information about the two major risk factors for puncture wounds.

First, a wound infection can occur when dirt is pushed deep into the skin by the object causing the wound -- typically a nail. As you have discovered, these wounds are very difficult to clean out. Your idea of squeezing a little extra blood out is a good one, but not necessarily sufficient to thoroughly clean the wound.

The second problem that can be associated with a puncture wound is an infection of the bone. If a nail penetrates deep into the foot, it can hit a bone and introduce bacteria into the bone. This risk is especially great if the nail has gone through a pair of tennis shoes. The foam in tennis shoes can harbor bacteria (Pseudomonas) that can lead to serious infection. If the nail is difficult to remove, this can be an indication that it may have penetrated the bone.

Now, let’s look a few first-aid steps to care for puncture wounds. The first thing to do is to wash your own hands. Then place the injured area under a stream of water for at least five minutes to rinse it out as much as possible. Wash the area with soap. Next, look -- without probing -- for objects inside the wound. Finally, apply antibacterial ointment and a clean bandage. You may want to keep the foot elevated for several days, depending on the severity of the puncture wound.

If, while you are examining the wound, you see any objects or feel anything suspicious, do not try to remove them yourself. Instead, go to your family physician’s office or the nearest hospital emergency department. Even if you don’t think there is anything inside the wound, but a piece of the object that caused the injury is missing, it’s still a good idea to seek medical attention.

In your case, because the puncture wound occurred through sneakers, or tennis shoes, I’d suggest you see a doctor for the reasons I explained earlier. Also, your statement that it felt like bone may have been hit gives me concern.

It’s also important to seek medical care if any of the following are true: the nail penetrated especially deep and/or was hard to remove, you are diabetic, you are elderly, or you are taking drugs that can suppress the immune system (such as cortisone-related medications).

Finally, think about tetanus anytime you get a puncture wound -- especially if you cut yourself when you’re outdoors or your puncture wound is deep. If you receive such a wound and it’s been more than five years since your last booster, ask your family doctor, your local health department, or a physician in your hospital emergency department for a tetanus shot.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.