From the Guidelines
A puncture wound through a sandal carries a significant risk of infection due to potential contamination from both the puncturing object and the footwear itself, and immediate cleaning and monitoring for signs of infection are crucial. According to the most recent and highest quality study 1, puncture wounds can lead to soft tissue infections, including cellulitis, abscess, myositis, septic arthritis, or sinus tract, especially if a foreign body is retained. The risk of infection is elevated because puncture wounds create deep, narrow channels that can trap bacteria deep in tissues where oxygen levels are low, creating ideal conditions for certain bacteria to thrive, particularly those commonly found on the ground and footwear.
Key Considerations
- Clean the wound immediately with soap and water, then apply an antiseptic like hydrogen peroxide or povidone-iodine
- Cover with a clean bandage and change it daily
- Monitor for signs of infection including increasing pain, redness, swelling, warmth, pus, red streaks extending from the wound, or fever
- If the puncturing object was rusty or dirty, or if you haven't had a tetanus shot within the last 5-10 years, seek medical attention for a tetanus booster within 48 hours, as recommended by the CDC 1
- People with diabetes, peripheral vascular disease, or compromised immune systems should see a healthcare provider promptly as they face higher infection risks
Imaging Evaluation
If a retained foreign body is suspected, imaging evaluation should be performed to determine the presence or absence of the foreign body, as recommended by the American College of Radiology 1. Radiographs are indicated for initial imaging, especially if the composition of the material is unknown, and are well suited in the detection of radiodense foreign bodies such as metal, graphite, and stone. Ultrasound (US) or computed tomography (CT) may be used to detect radiolucent foreign bodies such as plastic, rubber, or wood.
From the Research
Risk of Infection with Puncture Wound through Sandal
- The risk of infection with a puncture wound through a sandal is a concern, as any wound can quickly become infected if not properly cleaned and irrigated 2.
- It is essential to clean and irrigate the wound with sterile saline or tap water, as there is no evidence that antiseptic irrigation is superior 2.
- Occlusion of the wound is key to preventing contamination, and suturing can be completed up to 24 hours after the trauma occurs, depending on the wound site 2.
- Tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years, as tetanus is a potential risk with puncture wounds 2, 3, 4.
- The management of tetanus includes reducing muscle spasms, rigidity, and autonomic instability, neutralization of tetanus toxin, wound debridement, and administration of antibiotics to eradicate locally proliferating bacteria at the wound site 3, 4, 5.
- Identifying and managing wound infection early can contribute to faster wound healing and reduce the risk of negative outcomes 6.
- Prevention and management options for wound infection include proper wound care, antibiotics, and tetanus toxoid administration 2, 3, 6, 4, 5.