MANUAL MINORS
A puncture wound of the foot occurs when a sharp or pointed object penetrates the skin and underlying tissues, such as nails, glass, or other materials. These injuries are common and may be complicated by the potential introduction of bacteria, risk of infection, and in some cases, damage to deeper structures such as tendons, nerves, or bones. If the object penetrates through footwear, there is a specific risk of infections like those caused by Pseudomonas.
Diagnosis
The diagnosis is based on the account of the accident, accompanied by localised pain, bleeding, and possible swelling around the wound site. It is important to assess the depth of the injury and check for any retained foreign bodies in the foot. X-rays may be requested to rule out fractures or radiopaque foreign bodies, while ultrasound or CT scans can be useful for more complex wounds.
Differential Diagnosis
Condition | Key Difference |
|---|---|
Incised wound | Usually has more defined edges and less depth than a puncture wound. |
Foreign body infection | Progressive swelling and discharge, with a history of retained object. |
Foot abscess | Subcutaneous pus collection that may form after untreated infection. |
Open fracture | Bone injury with exposure, visible on X-rays. |
Emergency Management
In the emergency department, the wound should be carefully cleaned with saline and antiseptic soap to prevent infections. Any visible foreign body is removed, and the wound is assessed for its depth and potential damage to deeper tissues.
Depending on the severity and infection risk, prophylactic antibiotics are administered, especially if the object penetrated through footwear. If a tetanus booster has not been administered recently, it is crucial to give a tetanus toxoid booster dose.
Definitive Treatment
Definitive treatment involves closing the wound if there are no signs of infection, or leaving it open if there is a high risk of infection. In some cases, surgical intervention may be needed to remove foreign bodies or drain any formed abscesses.
Follow-up care includes monitoring for signs of infection (redness, heat, discharge) and, if necessary, starting or adjusting antibiotic therapy. Complete healing may take days or weeks, depending on the severity of the wound and whether complications arise.
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