From the Research
Yes, a patient who has completely removed a nail they stepped on should get an X-ray. Even when the nail has been completely removed, there is a risk that a piece of the nail or other foreign material remains embedded in the foot. Additionally, the nail could have penetrated deep enough to damage bones, joints, or tendons, which would not be visible during external examination. The X-ray will help identify any retained foreign bodies, bone fractures, or joint involvement that might require surgical intervention or specific antibiotic treatment. This is particularly important because puncture wounds are at high risk for infection, especially if foreign material remains in the wound.
While waiting for the X-ray, the wound should be cleaned thoroughly with soap and water, and the patient should receive tetanus prophylaxis if their immunization status is not up to date. Deep puncture wounds from nails often require antibiotics to prevent infection, typically with coverage for Staphylococcus and Streptococcus, such as cephalexin 500mg four times daily for 5-7 days. According to the most recent study 1, ultrasound examination has low sensitivity for detection of foreign bodies following a puncture wound of the foot, and therefore, should not be relied on when deciding to avoid surgery.
Key considerations in managing this patient include:
- Thorough wound cleaning and tetanus prophylaxis
- Antibiotic coverage for common pathogens
- X-ray to assess for retained foreign bodies or bony damage
- Possible surgical intervention if foreign material is retained or if there is significant tissue damage. The study by 1 highlights the importance of a thorough assessment, including imaging, to guide management decisions in patients with puncture wounds.