Puncture wounds, particularly to the plantar surface of the foot, are common and occur in all age groups. For example, over 7 percent of patients with lower extremity trauma who presented to an emergency department in one survey had plantar puncture wounds . Patients seek medical attention for these wounds for a variety of reasons including:
- Questions about the need for tetanus immunization
- Pain relief
- Treatment of established infection involving soft tissues or musculoskeletal structures
The clinical aspects and treatment approach to puncture wounds are reviewed here. Puncture wounds that occur in specialized settings such as water exposure are discussed separately. (See "Soft tissue infections following water exposure".)
Puncture wounds can occur in a broad array of circumstances. The majority of plantar puncture wounds are due to nails; less commonly, glass, wood, or other metal objects besides nails are the source of the puncture. In one series of children, these wounds occurred more often in the months of May through October . Superficial wounds generally heal without complications, but deeper penetration from the puncture is a risk factor for more serious infection. Puncture wounds of the metatarsal-phalangeal joints or surrounding tissue often penetrate deeper because this is a weight-bearing area .
Serial analysis of a patient population over a seven-year period has identified risk factors for infection [4-6]. The risk of infection was increased in patients who had either puncture wounds to the forefoot or wore shoes at the time of injury. A case control study evaluated 146 patients hospitalized with puncture wounds, 77 of whom had diabetes mellitus, some with neuropathy . The diabetic patients presented to clinicians later following puncture injury than patients without diabetes (8.7 versus 5.3 days) and more often developed osteomyelitis (35 versus 13 percent). They were also five times as likely to require multiple operations and 46 times as likely to have a lower extremity amputation .