The $2,000 Rusty Nail!

It all started with a late Saturday afternoon phone call. My hairdresser, Anne, called to ask if I could possibly look at her foot. Now! It seems that she and her daughter were in a creative mood while doing yard work that afternoon. They decided to rip up an old deck and make a new flower bed. Unfortunately, that old deck had a lot of ancient rotted wood held together with rusty nails. Anne was unlucky enough to have stepped on one of those rusty nails and had it stuck in her foot. Her daughter removed the board with the nail, but now, just a few hours later, Anne was quite concerned with the way her foot looked. She had cleansed the area with peroxide and put some ointment on it; but now her foot was red and swollen. Help!

Anne came over to my house so I could look at her foot. She had a typical puncture wound on the bottom of her foot with redness surrounding the wound and lots of drainage. It definitely looked like she may still have part of the nail and even maybe part of her shoe still in her foot. Infection was setting in! Off to the ER she went for x-rays and I scheduled an operating room to clean out the wound.

Her x-rays showed at least 50 small pieces of metal still in her foot. After I performed surgery to clean the wound, spending an hour taking small pieces of rust and metal shavings, as well a piece of sock and shoe out of her foot; Anne’s foot was on it’s way to recovery. Unfortunately, her wallet was $2,000 lighter after paying her deductible. So much for saving money by doing your own yard work!

What have we learned from Anne’s story? Hire yard workers? No, a better lesson is to address puncture wounds immediately! They are often much more contaminated than they look. Puncture wounds are extremely common in the foot. 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.

Foreign bodies 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 non-sterile object. 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. X-rays may even be needed to evaluate the bone structure 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!