Open Wound of the Foot: First Aid, Treatment and Healing

First aid for an open wound on the foot

1. Stop the bleeding. Press firmly on the wound with a clean cloth or gauze for 10 minutes without lifting to check. Sit or lie down and raise the foot above the level of your heart.
2. Clean it. Rinse under clean, running tap water for several minutes. Wash the skin around it with soap, keeping soap out of the wound itself. Remove small bits of dirt with tweezers cleaned in alcohol. Hydrogen peroxide and iodine damage healing tissue and are not needed.
3. Protect it. Apply a thin layer of petroleum jelly or an antibiotic ointment and cover with a non-stick dressing. Change it daily or when it gets wet or dirty.
4. Offload it. Wear a roomy, closed shoe or a post-op shoe, and limit walking for the first few days. Pressure and friction are the main reasons foot wounds reopen.
5. Check your tetanus status. Foot wounds are often contaminated with soil.

Types of open foot wounds

Open wound on top of the foot

The skin on top of the foot is thin, with little padding. The extensor tendons that lift the toes and the main veins and nerves run just beneath it. A cut here that seems small may still divide a tendon. Check that you can lift each toe against light resistance. If a toe droops or will not lift, a doctor needs to examine and possibly repair the tendon. Wounds on top of the foot are also rubbed by shoe tongues and laces, so pad the area or loosen your laces.

Open wound on the bottom of the foot or heel

The sole has thick skin and a fatty pad that bears your whole body weight with every step. A large open wound on the bottom of the foot heals slowly, because each step pulls the edges apart. Doctors often stitch sole wounds with stronger sutures and leave them in longer, about 10 to 14 days, and you may need crutches or a special shoe.

Heel wounds have their own problems. Deep cracks (heel fissures) can split open and bleed, especially with dry skin, diabetes or thyroid disease. Pressure sores on the heel develop in people who lie in bed for long periods. To heal an open wound on the heel:

• keep weight off it, using a heel cup, padding or offloading boot
• keep the wound moist with a dressing, and the surrounding skin moisturized, but not between the toes
• treat cracked heels early with urea-based creams
• see a doctor if it is not clearly smaller after 1 to 2 weeks

Puncture wounds of the foot

Stepping on a nail is the classic foot puncture. The entry hole looks small, but the object can drive dirt, sock fibers and bacteria deep into the tissue. Punctures through the sole of a rubber-soled sneaker carry a particular risk of Pseudomonas infection of the bone or joint, which may appear 1 to 3 weeks later as returning pain and swelling. See a doctor within 24 hours for any foot puncture wound, keep it clean and watch closely for late infection.

How a doctor treats an open wound on your foot

A doctor or nurse will ask how it happened, when, what caused it and whether you have diabetes or circulation problems. They will check blood flow, sensation and toe movement, then:

• Numb and explore the wound to look for foreign bodies, tendon damage and joint involvement.
• Irrigate it thoroughly with saline under pressure.
• Order an X-ray if glass, metal or a fracture is possible. Wood and plastic may need ultrasound.
• Close it with stitches, staples, skin glue or adhesive strips. Most cuts are closed within 6 to 24 hours. Dirty wounds, bites and punctures are often left open to heal from the inside out.
• Give a tetanus booster if you are due, and tetanus immune globulin for dirty wounds in people never fully vaccinated. See tetanus.
• Prescribe antibiotics for bites, heavily contaminated wounds, punctures through shoes, and wounds in people with diabetes.
• Refer to a surgeon or podiatrist for tendon injuries, large skin loss or ulcers.

Signs of infection

Some redness and mild swelling at the edges is normal for 1 to 2 days. These suggest wound infection:

• pain, redness or swelling that increases after the second day
• warmth and red streaks running up the foot or leg
• pus, cloudy drainage or a bad smell
• fever or chills
• pain that returns days or weeks after a puncture seemed to heal, which can mean a deep bone infection (osteomyelitis)

Spreading redness of the skin is cellulitis and needs antibiotics promptly.

Healing time and what slows it

Small, clean cuts usually close in 7 to 14 days. Stitched foot wounds take 2 to 3 weeks to regain strength. Healing slows with:

• diabetes and high blood sugar
• peripheral artery disease or venous insufficiency
• smoking
• repeated pressure, tight shoes or walking too soon
• poor nutrition, steroids and older age

A foot wound that has not healed within about 4 weeks is called a chronic wound and needs specialist assessment of blood flow and pressure. People with diabetes develop diabetic foot ulcers most often on the ball of the foot, the big toe and the heel.

Preventing foot wounds

• Wear shoes outdoors, on beaches and around construction or yard work.
• Check your feet daily if you have diabetes or neuropathy, including between the toes, with a mirror if needed.
• Break in new shoes gradually and wear socks.
• Keep tetanus vaccination current: a booster every 10 years.

Frequently asked questions

How do you treat an open wound on the foot at home?

Press firmly for 10 minutes to stop bleeding, then rinse under running water and wash the skin around it with soap. Cover with petroleum jelly or antibiotic ointment and a non-stick dressing, change it daily, and limit walking. See a doctor if it is deep, gaping, dirty or a puncture.

Does an open wound on the foot need stitches?

It usually needs stitches if the edges gape apart, it is deeper than about 6 mm (1/4 inch), or it is longer than 1 to 2 cm on the sole or heel. Get it closed within 6 to 24 hours. Punctures and bites are usually left open.

How long does an open wound on the bottom of the foot take to heal?

A small cut on the sole often heals in 1 to 2 weeks, but larger wounds take 3 weeks or more because walking stretches them. Stitches in the sole usually stay in 10 to 14 days. Diabetes and poor circulation slow healing considerably.

Should I keep a foot wound covered or let it air out?

Keep it covered. A moist, covered wound heals faster and scars less than one left to dry out and scab. Covering also protects the foot from dirt in shoes and socks. Change the dressing daily or whenever it gets wet.

Do I need a tetanus shot for a cut on my foot?

You need a booster if your last tetanus shot was more than 5 years ago and the wound is dirty or a puncture, or more than 10 years ago for a clean, minor cut. If you never completed the primary series, see a doctor for extra protection.

Why won't the wound on my foot heal?

The usual reasons are pressure from walking or shoes, infection, diabetes, poor blood flow to the foot, and smoking. A foot wound that is not clearly healing after 2 weeks, or has not closed after 4 weeks, needs a doctor to check circulation and look for infection.