Despite the "splendor of the grass," many foot injuries are sustained while barefoot. Although the grass invites pleasure to the feet, it also lends to injuries. Lacerations by unseen broken glass, puncture wounds by twigs, and fractured toes are some of summer memories. These wounds serve as ports of entry for bacteria, fungi, yeasts, and dirt.

Many patients are not up to date with their tetanus immunizations prior to injury. (A booster is needed every 10 years to enhance the immune system.) This precautionary measure protects against Clostridium tetani, a well known contaminant in the yard. A bare foot is merely a welcome victim for this bacteria. C. Tetani produces a toxin that is dangerous to humans. This toxin causes such a severe muscular contraction (lock-jaw) that eventual respiratory collapse will occur. Although a puncture wound by a rusty nail is thought to cause a tetanus infection, any wound that allows soil or dirt into the body will cause a tetanus infection. Many patients omit to update their "booster." Therefore, while at your next visit with your family physician, request a tetanus booster and remember the year it was administered.

A superficial cut can cause as much hardship as a deep cut. For this reason, all wounds, regardless of appearance, must be treated with antibiotics. The choice of antibiotic is based on its effectiveness to treat and protect the patient’s limb and life, not merely on the cost of the drug. Keeping this in mind, antibiotics are relatively inexpensive. In order to ensure that an appropriate antibiotic is used, the wound should be cultured prior to administration of the drug. Thus, a more effective antibiotic can be prescribed should the first choice not be the best available for treatment of the wound.

Wounds to the foot most always involve some type of foreign body. Lint from socks, fibers from shoes, or dirt from the earth will gain entry through the wound. This debris will lead to stubborn infections, therefore, a thorough cleansing of the wound is necessary. Some wounds will be deep and mandate a surgical approach. It is important to note that tendons, arteries, nerves, and bone can be insulted, although this may not be evident to the naked eye. Repair should be immediate. A golden period is within 6 to 8 hours after the injury. Should more time pass, a 3 to 4 day delay is needed to allow swelling to subside, so the wound may be closed without harm. Any exposed bone should not be closed immediately; doing so will lead to bone infection. This possibility will be discussed by the attending physician.

In summary, lacerations can often be prevented by wearing shoes or sandals. If an injury should occur, do not delay intervention. Also remember to update your tetanus immunization and be sure to take all antibiotics as prescribed. But most of all, enjoy the remainder of summer safely.

Dr. Graham has been in private practice in Effingham since 1989 and is on staff at St. Anthony's Memorial Hospital and Effingham Ambulatory Surgical Treatment Center. He is Board Certified by the American Board of Podiatric Surgery and American Board of Podiatric Orthopaedics and Primary Podiatric Medicine. Dr. Graham is a Fellow of the American College of Foot and Ankle Surgeons, the American College of Foot and Ankle Orthopaedics and Medicine, and American Professional Wound Care Association. He is also a member of the American Podiatric Medical Association and the Illinois Podiatric Medical Association.

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