How To Address Puncture Wounds

By Michael Keller, DPM, and Jacob D. Fassman, DPM
Continuing Education Course #156
September 2007

I am pleased to introduce the latest article, “How To Address Puncture Wounds,” in our CE series. This series, brought to you by the North American Center for Continuing Medical Education (NACCME), consists of complimentary CE activities that qualify for one continuing education contact hour (.1 CEU). Readers will not be required to pay a processing fee for this course.

Seemingly benign puncture wounds may have potentially serious complications, including osteomyelitis, when there is delayed treatment. Accordingly, Michael Keller, DPM, and Jacob D. Fassman, DPM, detail what one should look for during an exam, discuss what imaging techniques are effective and review proper antibiotic use for such wounds. They also discuss the treatment of puncture wounds in patients with diabetes.

At the end of this article, you will find a nine-question exam. Please mark your responses on the enclosed postcard and return it to NACCME. This continuing education course will also be available on Podiatry Today’s Web site ( so you can submit your responses online. I hope this CE series contributes to your clinical skills.


Jeff A. Hall
Executive Editor
Podiatry Today

INSTRUCTIONS: Physicians may receive one continuing education contact hour (.1 CEU) by reading the article on pg. 77 and successfully answering the questions on pg. 82. Use the enclosed card provided to submit your answers or log on to and respond via fax to (610) 560-0502.
ACCREDITATION: NACCME is approved by the Council on Podiatric Medical Education as a sponsor of continuing education in podiatric medicine.
DESIGNATION: This activity is approved for 1 continuing education contact hour or .1 CEU.
DISCLOSURE POLICY: All faculty participating in Continuing Education programs sponsored by NACCME are expected to disclose to the audience any real or apparent conflicts of interest related to the content of their presentation.
DISCLOSURE STATEMENTS: Drs. Keller and Fassman disclosed that they have no significant financial relationship with any organization that could be perceived as a real or apparent conflict of interest in the context of the subject of their presentation.
GRADING: Answers to the CE exam will be graded by NACCME. Within 60 days, you will be advised that you have passed or failed the exam. A score of 70 percent or above will comprise a passing grade. A certificate will be awarded to participants who successfully complete the exam.
RELEASE DATE: September 2007
EXPIRATION DATE: September 30, 2008
LEARNING OBJECTIVES: At the conclusion of this activity, participants should be able to:
• review what to look for when evaluating a puncture wound;
• discuss the pros and cons of X-rays, computerized tomography and radionuclide imaging in relation to the diagnostic workup of puncture wounds;
• discuss gram-positive and gram-negative organisms that can be found in puncture wounds;
• describe special considerations for treating puncture wounds in patients with diabetes; and
• discuss the judicious use of antibiotics and what antibiotics can be effective for different kinds of puncture wounds.

Sponsored by the North American Center for Continuing Medical Education.

Plantar puncture wounds are injuries that podiatric physicians commonly encounter. Clinicians often see puncture wounds in children who have played outdoors with or without shoes.1 Many of these wounds are the result of nails, sewing needles, broken glass, wooden toothpicks, tacks, thorns and animal bites.1 Most wounds heal uneventfully.

Add new comment