The top four reasons not to walk around without shoes are as follows: sewing needles, glass, wood (toothpicks) and metal.
Year after year, once the Memorial Holiday has been celebrated, shoes are often left behind in the house, around the pool, or on the beach blanket! During the summer months, patients complain that shoes can be “constricting,” “hot,” and “uncomfortable,” but I can assure you that nothing will be more uncomfortable than a foreign object that’s found its way into the sole of your foot.
If you step on an object, the initial response is to immediately extract it from your foot, but this may not always be the best course of action. Unlike splinters on the hand, when you step on an object the potential for it to penetrate far into the sole of the foot is great, for the simple fact that you’ve stepped on it! Refrain from extracting the object yourself, especially if there is immediate and profound bleeding or if you have an immediate loss of sensation to the foot/toes or burning and tingling sensations. These may be signs that important structures within the foot have been penetrated and without visualization of those structures, more damage can be induced upon retrieval of the object! Getting yourself to the Emergency Room is your best course of action with this type of injury.
In such a situation it is important that you know a few things about your health to help guide appropriate treatment once you’ve reached the hospital. It is important to know if you have been immunized against Tetanus bacteria and how current your immunization is. If your immunization or “booster” shot was within the last 5 years, it is unlikely that you will need to receive a “booster” in the emergency department, however, if your last “booster” shot was greater than five years ago, you will need to a “booster” shot to ensure coverage against Tetanus bacterium. If you have never been immunized, you will be given a series of two injections: one for immediate immunization against tetanus bacteria and a subsequent injection for long-term immunization.
Knowing which medications you are allergic to and what your body’s response to taking those medications is will help the ER Physician in prescribing an antibiotic. Whether the foreign object stays lodged in the sole of the foot or not, it carries the potential to generate infection and initiate an immune response by the body. The reason it carries this potential is because most objects encountered while walking barefoot are not sterile and thus bacteria is inherent to them. Once the skin barrier is broken and the object enters the sole of the foot, infection becomes a possibility and the body identifies that object as foreign and works to “fight against” it.
After initial treatment has been started, the Podiatric Physician “On-Call” will come and evaluate your injuries in the emergency department. Depending on the type of object that is lodged in the foot and whether there is immediate danger to your foot or not, will determine the Podiatrist’s next course of action. They may first ask for x-rays, an MRI, CT scan or Ultrasound of the foot in order to locate the object, determine what, if any structures the object is penetrating and to better determine the next course of action in treating your injury. If there is imminent danger to your foot, meaning there are concerns about viability of the tissue, nerve penetration and compromised blood supply, the Podiatrist may want to take you to the operating room immediately to extract the object, clean out the tissues, and repair any damage.
No matter what the immediate course of action, once the object has been removed you will be given a 10-day course of antibiotics for prevention of infection. You will also need to follow up with the Podiatric Physician who treated you in the hospital, for evaluation of the site of penetration and to monitor healing.
The next time you think about walking around the house or the backyard without shoes, think again! Going barefoot is certainly not worth the risk of stepping on an object, lodging it into your foot and increasing your chance of infection with a subsequent recovery period during the beautiful summer vacation months!
For the diabetic population, especially those patients with neuropathy, walking without shoes is never a good idea. You are less likely to feel an object penetrate your foot, thus you are less likely to seek treatment and more likely to contract infection with poor healing outcomes due to the nature of diabetes.
