What’s more dangerous? Stepping on a rusty nail barefoot, or stepping on a clean nail through sneakers?
Answer (Also see Disclaimer)
Puncture through footwear.
This doesn’t seem to get enough public attention, but I think it’s really important to know.
If you step on a nail with bare feet, it’s usually not too much of a problem because the bacteria on the skin (Staphylococcus and Streptococcus, “staph and strep”) are relatively easy to kill.
However, if a nail punctures through a sneaker or sandal, the bacteria that grows there can be a big problem. It’s called Pseudomonas and only a few antibiotics work well against it. Plus, it can even cause a bone infection (osteomyelitis) that can be serious and need prolonged treatment.
For those reasons, when the skin is punctured through footwear, seek medical attention. It doesn’t have to be immediately, but I would say by the next day.
I generally recommend starting a prescription for an antibiotic called ciprofloxacin, if there are no reasons not to (such as allergy).
In both instances you will usually need a Tetanus booster if it’s been more than 5 years since your last immunization… not because of the rust but from the dirt on the nail and puncture through the skin. This is also not a reason to go to the hospital immediately. Often you can get a tetanus shot at a public health office, pharmacy, or clinic.
This is an excerpt from PART 4: ARMCHAIR EMERG DOC in a section called “Tips and Tricks for Common Conditions”
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