What is the recommended treatment for a splinter in the heel?

Treatment of a Splinter in the Heel

For a splinter in the heel, remove it immediately using direct visualization and forceps extraction via incision along the splinter's long axis, and refer to a podiatric foot and ankle surgeon if the splinter is deep, elusive, or located near important structures. 1

Immediate Removal Approach

• Remove reactive foreign bodies (wood, thorns, vegetative material) immediately before inflammation or infection develops 1
• Superficial horizontal splinters visible on inspection should be exposed completely by incising the skin over the entire length of the splinter's long axis 1
• Once exposed, lift the splinter out with forceps 1
• Do not delay removal waiting for "demarcation" as you might with dry gangrene—splinters require prompt extraction 1

When to Refer to Podiatry

Refer deeper splinters to a podiatric foot and ankle surgeon, especially those close to nerves, tendons, blood vessels, or other vital structures 1

Additional referral indications include:

• Elusive splinters requiring imaging modalities for localization 1
• Suspected neurologic involvement (burning, tingling, or nerve irritation symptoms) 2
• Any splinter removal that proves challenging in the primary care setting 1

Key Technical Considerations

• For superficial splinters: use direct incision technique along the long axis rather than attempting to "dig out" the splinter 1
• Ensure complete visualization before extraction to avoid pushing the splinter deeper 1
• The heel's thick plantar soft tissue can make visualization difficult, increasing the need for specialist referral 2

Common Pitfalls to Avoid

• Do not attempt removal of deep heel splinters in primary care—the heel contains important neurovascular structures and thick fascial compartments that require specialist expertise 2
• Avoid incomplete removal, which can lead to retained foreign body with subsequent infection or granuloma formation 1
• Do not underestimate the complexity of heel anatomy—plantar wounds can communicate with dorsal compartments through fascial planes 2