Puncture wounds

Puncture wounds (Fig. 4.33) are potentially serious injuries that may first appear as trivial superficial pinpoint wounds. These injuries are caused by a foreign body that may have penetrated the footwear as well as the foot. The foreign body (nail, needle, staple, glass, wooden splinter or other object) may inoculate bacteria into the wound resulting in severe infection. Some of the most serious foot infections we have seen have followed puncture wounds. In some cases the initial wound has fully healed but within a few days the 'volcano' has erupted with severe tissue destruction.

Treatment of puncture wounds is as follows:

• If possible, the foreign body should be inspected to see whether it is intact, or whether a piece has broken off which might remain in the foot

• The foot should be X-rayed and a radio-opaque foreign body sought. Even clear glass will usually show up

• The wound should be probed and irrigated, although this may be difficult when the portal of entry is small. In

Fig. 4.33 This patient arrived at the foot clinic with a drawing pin still in her foot. The puncture wound can be clearly seen.

neuropathic patients it may be possible to enlarge the wound to ensure thorough cleaning. Local anaesthesia maybe required for sensate individuals

• Wide-spectrum antibiotics should be prescribed

• The wound should be inspected at frequent intervals

• The patient should be asked to report any pain, swelling, discomfort or systemic signs or symptoms immediately

• Tetanus prophylaxis may be needed.

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