Remember how much fun it was to run barefooted, your feet brushing along the freshly cut grass? Remember also how your cosmic high was smashed to smithereens, as soon as your foot stepped on that rusty nail?

 Puncture w0unds are all too common. For the most part these wounds are relatively benign, but some caveats are in order.

Believe it or not, you are better off if you stepped on something without shoes rather than with shoes. Why? The object, which is often a nail, will carry a very small piece of the shoe’s sole with it on its way through your skin. It is that small, usually rubber section of the shoe which underneath your skin can cause some nasty problems. Bacteria like foreign bodies such as rubber. Certain ‘bad boy’ bacteria such as Pseudomonas seem to thrive on bits of rubber soles. These guys can wreak havoc, causing not only skin infections such as cellulitis and abscesses, but also bone infections.

Bone infections or osteomyelitis can occur when a nearby area such as the skin and soft tissue underneath is infected. The infection spreads to the bone, where it destroys the bone marrow and sometimes can cause death of parts of the bone. These bone infections are very difficult to treat, usually requiring weeks to months of antibiotic therapy. Sometimes surgery is required to clean out the bone.

Certain persons are more likely to have worse infections. Diabetics, due to lack of good blood supply, elevated blood sugar and poor nerve function have a greater risk of bad infections. So too do smokers, patients with malnutrition, cancer or poor blood supply to their feet. In some cases infections can lead to breakdown of the skin (skin ulcers) to the point where amputation of part or all of the foot is needed.

Another issue is tetanus. Rusty nails can carry tetanus. Although tetanus is very, very rare it is almost always fatal. A simple tetanus booster every five years for clean wounds or every ten years for dirty ones, is all that is needed. (Unless of course you have never been immunized against tetanus. For those individuals an additional treatment would be necessary. Talk to your doctor.) Tetanus vaccine is often coupled with pertussis or whooping cough vaccine and is very safe.

If you do step on a nail, clean off the wound and call your doctor to see if you need antibiotics to prevent infection and if your tetanus immunizations are up to date.

Having a back to nature experience? Keep the shoes off, when you run through that meadow,because aux natural means no risk of rubber under your skin!

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  1. Ana Rodriguez

    I stepped on a nail yesterday. I was wearing some flip flops. It started bleeding. I was looking on yahoo answers. And it said that I could loose my foot or my life. If one day or 2 days pass will I die? I have never tooken the tetanus shot.

    September 15th, 2013 10:44 am

  2. ERDoctor

    Dear Ana-
    No worries-you will not lose your foot or die. You have about 10 days to get your tetanus vaccine along with the first dose of your tetanus immunization (You will need further doses). I recommend that you see your doctor and obtain the vaccines. Have him or her examine your foot as well.

    Rick Tietz, MD

    September 15th, 2013 4:47 pm

  3. Tamia Phillips

    I stepped on a nail today getting on the bus. It went through my flip flop and broke the skin on my foot. It was bleeding and now it hurts really bad when I walk. Do I need a tetanus shot? I hope I won´t have to get my foot amputated.

    September 18th, 2013 11:11 am

  4. ERDoctor

    No worries-your foot will definitely not need to amputated. You might need some antibiotics though. Very small pieces of rubber might have gained entranced into the skin of your foot. Talk to your doctor about antibiotics. Also, you have up to 10 days after the puncture wound to update your tetanus vaccines. Hope this helps!
    Rick Tietz, MD

    September 20th, 2013 9:04 pm

  5. louis

    At work… I stepped on a nail and I immediately poured water on it and wiped it and in 2hrs I can clean it. Will that be enough or do I need to see a doctor? Also it did bleed and I can see a blood spot under skin.

    September 28th, 2013 2:00 pm

  6. Brad

    This is a very helpful article. I didn’t even think of pieces of rubber entering the wound…
    I stepped on a severely rusted nail yesterday. It was broken but it still went through my shoe and into my foot. I didn’t notice any blood so I wasn’t worried but today I looked on the sock I stepped on it with and there was a bit of blood so it did penetrate my skin. Now Im worried.

    I don’t have health insurance and haven’t had a Tetanus shot in over 10 years. The wound is small and I don’t believe it will get infected but Im still worried that I might still be at risk of DYING! and Im not ready!

    I guess what Im asking is, If I dont go in for a shot, and my wound heals nicely, what are the odds that tetanus got into my bloodstream?

    Thank you much.

    September 28th, 2013 3:05 pm

  7. ERDoctor

    Thanks for your comment. The odds of getting tetanus are small and tetanus is very rare. However, tetanus is almost always fatal. I strongly recommend that you get a tetanus vaccination within 10 days. You should try the local public health clinic, which I am quite sure, will offer inexpensive vaccinations.

    Rick Tietz.MD

    September 28th, 2013 8:25 pm

  8. ERDoctor

    You should see a doctor because of the risk of infection, especially as you were wearing shoes ( a reasonable assumption, as you were at work) and thus could have a tiny piece of rubber within the wound. Also, your doctor can give you a tetanus vaccination, if needed.

    Rick Tietz, MD

    September 28th, 2013 8:27 pm

  9. Brenda Lyn

    Hi, i stepped on a rusted earring a few hours ago and i was wearing flip flops. It really went through and i think 0.25 to 0.5 inch went through my sole. I immediately got myself shot with tetanus toxoid 0.5 ml and ATS 3000 units. Is that ok? It bled a little. I immediately cleaned it alcohol. Is that ok? Will it get worse. Please advise. Tnx

    September 28th, 2013 10:12 pm

  10. ERDoctor

    You should clean the wound daily with soap and water. Ideally, you need to see a doctor to receive antibiotics.

    Rick Tietz, MD

    September 30th, 2013 8:15 pm

  11. Amy

    Barefooted, I stepped on a rusty nail about 3-4 months back and it went in about 1/2 an inch or more into the arch of my foot. I did immediately get it clean and went to the er that day for the shot, no biggie. They did not probe the wound though. Now I am experiencing some pain… From the scar in my arch, up the side of my heel and around my ankle bone are a little puffy and VERY tender to the touch, which means it is not comfortable to wear shoes all the time. I’ve taken powerful antibiotics for an upper respiratory infection in the last two months, so I know it isn’t an infection. Could I have damaged a nerve or something? Should I see an orthopedic doctor?

    November 13th, 2013 12:20 pm

  12. ERDoctor

    Ideally you should see your doctor to further evaluate your foot. It could be a small abscess (pus pocket), which would not get better even with antibiotics. It could also represent a neuroma or a nerve swelling. Other possibilities exist. Bottom line: see your doctor. Hope this helps,

    Rick Tietz, MD

    November 14th, 2013 4:45 pm

  13. Daniel

    I stepped on a old moist rusty nail at work yesterday cutting trees near a junkyard.. Don’t know how deep it punctured through my skin but I quickly felt pain am never stopped hurting. I did took the tenatus shot but am still on pain and my foot is getting swollen. Can’t even walk because it hurts so bad when I put my weight on it. Please tell me what I need to do.

    November 19th, 2013 6:58 am

  14. ERDoctor

    You should see your doctor and have him or her prescribe some antibiotics. You might need an xray as well.
    Hope this helps,

    Rick Tietz, Md

    November 19th, 2013 11:33 am

  15. Cody

    While at work I dropped a board on my foot and a nail punctured the top of my foot 3 days later I went to the er because I didn’t know if I have had a tetanus shot at the hospital they gave me the shot and antibiotics I didn’t get the antibiotics filled because it wasn’t infected but had some spasms in my leg I don’t know if I’m just worrying too much or it is a sign of tetanus

    December 10th, 2013 10:57 pm

  16. ERDoctor

    It is very, very unlikely to be tetanus. You probably have spasm due to a muscle sprain. If the problem continues you should see your doctor.
    Rick Tietz., MD

    December 12th, 2013 11:55 am

  17. Lulu

    While I was walking from my shed I stepped on a rusty nail,it was outside,and I had flats on.It hurt a lot it bleed,but it was a tiny,tiny wound.I got my tetanus shot and its up to date but I was wondering if its still infected,because it was outside? I don’t know what to do,i can still walk on it but not for long.Im very very worried and confused.And when I came in I cleaned it with a plain swoob and I kinda rested on it.But,like I said please please help me! I’m very worried! thank you!:)

    December 15th, 2013 9:54 pm

  18. ERDoctor

    If you were wearing shoes, you might have a small piece of the shoe within the wound. This can cause infection. Best bet is to see your doctor and get some antibiotics. Until then, wash your foot frequently with soap and water.

    Rick Tietz, MD

    December 16th, 2013 4:27 pm

  19. lindsey

    About 2 years ago my boyfriend stepped on a nail that went thru his shoe while he was doing a roof. He never went to a doctor and now the spot is like a callis but he has throbbing pain in it constantly. Is it possibly a piece of his shoe or sock stuck that caused infection?? Thanks!!

    January 10th, 2014 5:47 pm

  20. ERDoctor

    Dear Lindsey,
    Yes it is possible that a small piece of his shoe is within the foot. If the pain is severe, consider seeing his doctor. An MRI or even ultrasound of the foot would pick up a foreign body. Antibiotics might help. Your doctor should examine his foot and decide whether or not further care is needed.

    January 19th, 2014 7:14 am

  21. ERDoctor

    You should definitely see your doctor, who can determine whether antibiotics are indicated. If it has been more than 5 years since your last tetanus shot, you will need that as well.

    Rick Tietz, MD

    March 2nd, 2014 11:30 am

  22. ERDoctor

    Yes, you will need a tetanus shot. You should see your doctor to arrange for this.

    Rick Tietz MD

    March 2nd, 2014 11:31 am

  23. just some teenager

    ok so i accidentally stepped on a very rusty nail it got through my shoes and got my foot,the thing is i didn’t bleed at all however i did saw where it hit me and left me a small hole,i tried washing it to be sure(even though way later,but i still did)
    I’m not sure if i had vaccines against tetanus,and i’m kind of worried of telling my family because i WILL sound stupid,however now it hurts a bit sometimes,and i feel like something is growing inside my leg,also sometimes it’s hard moving my leg,but the thing is that i didn’t bleed and these things are not really all that noticeable to me all time,however i would like to know if i should see a doctor or something,btw i’m only 14,and as i stated before i don’t know if i have taken before anything against it and the nail was really rusty,do i need help???(if it is of any help it happened yesterday)

    March 9th, 2014 5:26 pm

  24. Tina Edwards

    While I understand the need the for a tetanus shot, I’m confused by your repeated statement that tetanus is almost always fatal. The CDC lists the fatality rate at 13.4%, which is closer to almost always not fatal.

    March 10th, 2014 9:19 pm

  25. ERDoctor

    Dear Tina,
    I am unaware of those stats, but thanks for the update. Still, I believe that once contracted, the rare full blown tetanus infection carries a high mortality.
    Rick Tietz, MD.

    March 16th, 2014 9:56 am

  26. ERDoctor

    Most teenagers are in fact up to date on tetanus vaccines as these are required to attend school. However, there is a high incidence of infection. You should see your doctor, who might prescribe some antibiotics for you.
    Hope this helps!
    Rick tietz, MD

    March 16th, 2014 10:00 am

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