Stepping on a nail is a common injury that causes a puncture wound, often in the shape of a round hole. Puncture wounds can look small, but as they can penetrate deep into the skin, they can be difficult to clean and pose a risk for infection.
Initially, a puncture wound may not look serious, as they often bleed more internally than externally. However, as nails on the ground are often dirty, they can push soil, rust, wood, or clothing fibers into the foot.
In this article, we discuss how to carry out first aid for this injury, when to seek medical help, if a rusty nail causes tetanus, and how to recover at home.
If someone steps on a nail, they should take the following steps to clean and dress the wound:
- Thoroughly wash the hands with soap.
- Apply gentle pressure with a clean cloth to slow the bleeding.
- Flush the wound with clean water and soap as soon as possible for 5–10 minutes.
- If there is debris in the wound, disinfect some tweezers with rubbing alcohol and use them to remove as much as possible.
- Apply antiseptic, antibiotic ointment, or both to the wound area if available.
- Dress the wound with a clean bandage.
Once a person has dressed the wound, they should seek medical care and not put weight on the foot.
The American College of Foot and Ankle Surgeons suggest that people seek medical help within 24 hours after they step on a nail.
Stepping on a nail can push debris and bacteria into the foot. Even if a person cleans the wound thoroughly at home, or the wound looks small, there is still a risk of infection.
Clinicians estimate that 10% of people who step on a nail will develop an infection. Signs of an infection include:
A person should not wait until these symptoms develop to seek medical help. The best way to prevent an infection is early treatment. This may mean a visit to the hospital.
Rusty nails do not cause tetanus themselves, but they often occupy dirty or dusty areas that harbor Clostridium tetani, the bacteria that cause tetanus. Stepping on a nail can spread this bacteria to humans.
Wounds are the most common way people get tetanus. However, widespread vaccination has reduced tetanus infection in the United States by 99% since 1947, according to the U. S. Department of Health & Human Services.
All of these conditions are potentially serious. Tetanus can be fatal in two people out of every 10 who get it.
If a person who steps on a nail has not had a tetanus vaccination in the last 5 years, they should see a doctor right away so they can get a top-up.
Symptoms of a tetanus infection include:
- lockjaw, an inability to move the jaw
- a rigid facial expression
- drooling and difficulty swallowing
- muscle spasms and pain
- loss of bowel control
- difficulty breathing
Someone may not develop tetanus symptoms for up to 60 days after an injury. If someone has these symptoms after they step on a nail, they should dial the emergency number 911.
Most puncture wounds are minor and heal with no further issues. However, if a wound is deep, has ragged edges, or contains a foreign object, it is more likely to develop complications. These can include:
- an abscess
- cellulitis, which is an infection of the deep layers of the skin
- septic arthritis, or infection of the joints
- osteomyelitis, which is a serious bone infection
Osteomyelitis develops slowly, and may take days or months to appear. Around 1–2% of people with a foot puncture wound go on to develop this condition.
Many other types of infection can also occur if a person steps on a nail, including Pseudomonas, which often lives on rubber-soled shoes. Early treatment from a doctor or foot specialist is the best way to avoid these complications.
After someone receives medical treatment for stepping on a nail, they can recover at home. Recovery time will depend on several factors, such as how deep the wound is. A person can aid their recovery by:
- keeping weight off the foot for at least 24 hours
- elevating the foot
- keeping a clean dressing on the wound, and changing bandages according to a doctor’s instructions
- taking over-the-counter pain medication such as acetaminophen (Tylenol) or ibuprofen
- gradually reintroducing weight-bearing activities, such as walking, when the pain improves
If a doctor prescribes antibiotics, it is important to finish the course, even if the wound feels or looks better. Seek medical help if the wound does not improve, pain does not completely subside, or symptoms get worse.
Stepping on a nail causes a puncture wound, which often looks like a small hole in the foot. It may not bleed as much as a cut, but due to the risk of infection, this type of wound often requires medical attention.
A person can reduce the risk of complications with first aid. They should seek prompt medical care, and keep the wound clean. A person may also need a tetanus vaccine if they have not had one in the last 5 years.
If a person’s wound does not heal, continues to hurt, or shows signs of infection, they should seek further medical attention.