Tendon and nerve injuries should be examined for any laceration around the foot and the ankle. This patient has divided their extensor hallucis longus tendon.

Puncture wounds

Puncture wounds of the foot are common. A frequent presentation is the patient who treads on a nail sticking up through a plank of wood. This penetrates the shoe and goes into the sole of the foot. There appears to be a significant risk of infection, particularly as the depths of the wound cannot be fully cleaned.

Osteomyelitis is not unknown if the nail penetrates into bone. The wound should be cleaned as much as possible and dressed. If the hole is large, it should be irrigated. Tetanus prophylaxis should be provided. There are many opinions as to whether antibiotics should be used to try to prevent infection but no evidence either for or against this [6].