Puncture Wound

By David A. Thompson, M.D. 
March 22, 2017

911 warning

Puncture Wound

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Does this describe your symptoms?

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X-Ray - BB in Left Upper Arm

Puncture Wound - BB Gun

First Aid - Removing a Fishhook

Puncture Wound - With a Foreign Body


  • Skin is punctured by a narrow sharp object (e.g., a nail, pencil, toothpick)

General Information

  • Needlesticks: Any needlestick from a used or discarded needle should be reported immediately to the doctor. In some cases, medicines should be started to prevent transmission of the HIV (AIDS) virus.

  • Foot Punctures through Athletic Shoes: Puncture wounds into the bottom of the foot have a risk of infection of approximately 4%. This increases to 25% in patients with puncture wounds through athletic (tennis) shoes into the bottom of the foot near the toes. Pain persisting greater than 4-5 days after the injury is suggestive of infection.

  • Pencil Lead Punctures: Pencil lead is actually graphite (harmless), not poisonous lead. Even colored leads are nontoxic. However, they will cause a tattoo and should be scrubbed out.

If not, see these topics

First Aid:

FIRST AID Advice for Bleeding: Apply direct pressure to the entire wound with a clean cloth.

FIRST AID Advice for Shock: Lie down with feet elevated.


When to Call Your Doctor

call 911

Call 911 Now (you may need an ambulance) If

  • Puncture on the head, neck, chest, back, or abdomen that may go deep

call now

Call Your Doctor Now (night or day) If

  • You think you have a serious injury

  • Severe pain

  • Puncture on the head, neck, chest, abdomen that isn't deep

  • Puncture overlying a joint

  • Tip of the object is broken off and missing

  • Feels like something is still in the wound

  • Can't stand (bear weight or walk) on punctured foot

  • Needle stick from used injection needle, and you were possibly exposed to another person's blood

  • Sharp object was very dirty (e.g., a barnyard)

  • Setting was dirty and puncture occurred on bare foot

  • Dirt (debris) that can be seen in the wound is not gone after 15 minutes of scrubbing

  • Wound looks infected (redness, red streaks, swollen, tenderness)

  • Fever

  • No previous tetanus shots

call within 24 hours

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think you need to be seen

  • Diabetic and puncture wound of foot

  • Last tetanus booster was over 5 years ago

call within 24 hours

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns

  • Puncture through shoe (e.g., tennis shoe) and into bottom of foot

  • Pain has not improved after 3 days

home care

Self Care at Home If

  • Minor puncture wound and you don't think you need to be seen



  1. Cleansing: Wash the wound with soap and warm water for 15 minutes. For any dirt or debris, scrub the wound back and forth with a washcloth to remove it.

  2. Trimming: Cut off any flaps of loose skin that seal the wound and interfere with drainage or removing debris. Use a fine scissors, after cleaning them with rubbing alcohol.

  3. Antibiotic Ointment: Apply an antibiotic ointment and a Band-Aid to reduce the risk of infection. Re-soak the area and re-apply an antibiotic ointment every 12 hours for 2 days.

  4. Pain Medicines:

    • For pain relief, take acetaminophen, ibuprofen, or naproxen.

    Acetaminophen (e.g., Tylenol):

    • Take 650 mg by mouth every 4-6 hours. Each Regular Strength Tylenol pill has 325 mg of acetaminophen.

    • Another choice is to take 1,000 mg every 8 hours. Each Extra Strength Tylenol pill has 500 mg of acetaminophen.

    • The most you should take each day is 3,000 mg.

    Ibuprofen (e.g., Motrin, Advil):

    • Take 400 mg by mouth every 6 hours.

    • Another choice is to take 600 mg by mouth every 8 hours.

    • Use the lowest amount that makes your pain feel better.

    Naproxen (e.g., Aleve):

    • Take 250-500 mg by mouth every 12 hours.

    • Use the lowest amount that makes your pain feel better.

    Extra Notes:

    • Acetaminophen is thought to be safer than ibuprofen or naproxen in people over 65 years old. Acetaminophen is in many OTC and prescription medicines. It might be in more than one medicine that you are taking. You need to be careful and not take an overdose. An acetaminophen overdose can hurt the liver.

    • Caution: Do not take acetaminophen if you have liver disease.

    • Caution: Do not take ibuprofen or naproxen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of medicine. Do not take ibuprofen or naproxen for more than 7 days without consulting your doctor.

    • Before taking any medicine, read all the instructions on the package

  5. Expected Course: Puncture wounds seal over in 1 to 2 hours. Pain should resolve within 2 days.

  6. Call Your Doctor If:

    • Dirt in the wound persists after 15 minutes of scrubbing

    • It begins to look infected (redness, red streaks, tenderness, pus, fever)

    • Pain becomes severe

    • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.


March 22, 2017