Nail Puncture Wound; Complications & What to do

Nail puncture wound is a category of the puncture wound caused by stepping on a nail.

Complications from stepping on a nail can be serious. But with prompt at-home care and early medical treatment for signs of an infection, the outcome is positive and your wound should heal well. You may have scarring depending on the depth of the puncture.

There’s also a lower risk for developing tetanus if you’re up-to-date on your booster shot or if you get a booster shot within 48 hours after your injury.

On average, it can take two days to two weeks for an injury to heal. Recovery time is based on the depth of the puncture.

Some complications associated with nail puncture wounds

  • Tetanus: Rusty nails do not cause tetanus themselves, but they often occupy dirty or dusty areas that harbor Clostridium tetani, the bacteria that causes tetanus. Stepping on a nail can spread this bacteria to humans.

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


  • Abscess
  • Cellulitis, which is an infection of the deep layers of the skin
  • Septic arthritis, or infection of the joints
  • Osteomyelitis (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.

Read Also: Puncture Wound: First Aid & Home Remedies

First aid after stepping on a nail

If someone steps on a nail, they should take the following steps to clean and dress the wound:

  1. Thoroughly wash the hands with soap.
  2. Apply gentle pressure with a clean cloth to slow the bleeding.
  3. Flush the wound with clean water and soap as soon as possible for 5–10 minutes.
  4. If there is debris in the wound, disinfect some tweezers with rubbing alcohol and use them to remove as much as possible.
  5. Apply antiseptic, antibiotic ointment, or both to the wound area if available.
  6. 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.

Read Also: How much water is too much?

What to do immediately after having a nail puncture wound

Prompt treatment after a nail puncture can speed the healing process and prevent an infection:

  1. Wash your hands

Wash your hands before caring for any type of wound. Germs like bacteria could enter your body through a wound.

Clean hands with warm soapy water for at least 20 seconds. This is the equivalent of singing the Happy Birthday song twice. Dry your hands with a clean cloth.

  1. Stop the bleeding

Some nail punctures bleed, some don’t. If bleeding occurs, apply gentle pressure to stop bleeding and promote clotting. Be gentle: Too much pressure can worsen pain and bleeding.

  1. Clean your wound

A nail on the ground may contain bacteria or other germs that can make you sick, especially if it’s dirty or covered in rust. Cleaning your wound is one of the best ways to prevent complications like tetanus, a serious bacterial infection. The bacteria that causes tetanus can be found in dirt, dust, or animal feces.

To properly clean a puncture wound, start by rinsing the injury with clean water for about 5 to 10 minutes. This helps remove dirt and any lose debris.

Debris can include dirt or pieces of fabric from your sock. If necessary, use tweezers to remove debris from your wound. Clean the tweezers with rubbing alcohol beforehand.

Also, gently clean the skin around your wound with soap, water, and a washcloth.

  1. Apply antibiotic cream

Cleaning is important but it’s not enough. You should also protect the puncture to prevent an infection. After cleaning and drying your wound, apply a thin layer of a topical antibiotic cream such as Neosporin.

  1. Cover your wound

It can take several days for your wound to heal. During this time, wrap it in a bandage to protect and keep it clean. Change your bandages at least once a day, preferably after showering. Wait until any bleeding stops before applying a bandage.


When to get medical help

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:

  • Soreness
  • Inflammation
  • Swelling
  • Pus buildup or drainage
  • Warmth
  • Fever
  • Redness

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.


By Ubong Edet

A passionate Health and Safety professional with a good level of field experience and relevant certifications including NEBOSH, OSHA, ISO, etc certifications. An Health and Safety activist who believes in the growth and continual improvement of the profession. He is going all out to create awareness and safe precious lives.

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