LET’S start with a story: A diabetic patient of mine had been picking ackees from his tree. As instructed, he always made sure he didn’t walk around barefoot, especially in his garden. He had on his yard slippers which he found comfortable and were secured to his feet.

This man was very agile, so he was able to climb the tree many times to retrieve ackees. Once finished, he went to his back door to change into his house slippers. He kicked off one shoe and as he attempted to kick off the other, he noticed it wouldn’t budge. He looked down and noticed a six-inch, rusty nail had penetrated his shoe and was sticking out of the top of his foot.

Being a diabetic patient with nerve damage he could not feel a thing. Want to know what happened to him? I will tell you later.

PUNCTURE WOUND

A puncture wound is one caused by a foreign object entering the foot, usually by stepping on it. This is different from a cut, which produces a tear in the skin. Puncture wounds can produce a different challenge in that they can disguise a deeper injury.

Living in Jamaica where we often wear flip-flops, sandals or go barefoot, this is a common injury. I often get patients who have stepped on a sea urchin on the beach and they have spines embedded in their flesh. Others come in having trodden on glass, splinters, sewing needles, and other foreign objects. If left untreated, infection and other serious complications can occur.

All puncture wounds should be seen as “dirty” since something has penetrated the skin that is not sterile. Research shows that complications can be prevented if the patient seeks help as soon as possible. The deeper the wound, the greater the chance that infection will develop. The type of object that has caused the wound can also determine the severity of it.

TREATMENT

In minor cases, these are the steps that should be followed:

1. Remove the object if it is small and can easily be done.

2. Stop the bleeding. Apply direct pressure to the wound with a sterile gauze or clean cloth.

3. Clean and protect the wound. Rinse the area with salt water. Apply antiseptic or antibiotic cream and cover with sterile gauze to keep it clean and protect from further injury. The wound should be repeatedly redressed until it has healed.

4. Treat the pain. Over-the-counter painkillers can be purchased from the pharmacy, but always check to ensure that what you are buying won’t interact with any other medication you are taking or condition you may have. Try not to bear weight on the affected foot. Use a stick or crutch, if necessary.

5. Follow up. See your doctor if there are any signs of infection such as pus, throbbing, redness, or increased pain. Monitor your temperature, because if you get a fever, this can also be a sign of spreading infection. Speak to your doctor regarding a tetanus injection. If you haven’t had one within the last 10 years, then it may be advisable to get one.

Serious puncture wound

With a serious puncture wound it is very important that you seek medical help immediately. Your doctor or surgeon can ensure that the wound is cleaned thoroughly. They may numb the area so that deep cleaning can be achieved. X-rays may be required to determine whether something remains in the foot or if the bone and other structures have been damaged. Antibiotics will probably be prescribed.

So what happened to the man with the six-inch nail in his foot?

Thankfully, my patient did the right thing. The nail was too big and deeply embedded to remove, so he wrapped his foot and shoe in a towel and went to the emergency room of his local hospital.

That evening he had surgical intervention and sutures were put in his foot. He used a crutch for the next six weeks to avoid pressure on the area and came to see me for regular redressing and monitoring.

The foot has now completely healed with just a small residual ache if he stands for too long. This is an excellent outcome for this diabetic patient. Many are not so lucky. If he hadn’t sought treatment immediately, this could easily have ended with an amputation.

Angela Davis BSc (Hons) DPodM MChS is a podiatrist with offices in Montego Bay (293- 7119), Mandeville (962-2100), Ocho Rios (974- 6339), Kingston (978-8392), and Savanna-la- Mar (955-3154). She is a member of the Health and Care Professions Council in the United Kingdom.