The horse's hoof is a very complex structure. The tough outer wall surrounds layers of sensitive laminae ('leaves') that support, nourish with blood and, in turn, cover the underlying pedal bone. The sole consists of horny tissue and is similar to the hoof wall in which the outer surfaces are insensitive to pain, but lacks the hardness and strength of the outer layers of the hoof wall. The frog consists of firm rubbery tissue that acts as a cushion to help spread the forces associated with weight bearing. The sole joins the hoof wall at the white line. This marks the zone of transition between insensitive and sensitive tissue in the hoof wall. Punctures to the hoof rarely occur through the hoof wall itself, but punctures to all areas of the sole and frog are relatively common. These puncture wounds can range in significance from none at all to a severe life-threatening injury, depending on the site and depth of penetration.
What types of puncture wounds occur?
Most puncture wounds to the sole are associated with accidentally misdirected shoeing nails, shoeing or construction nails that have been picked up in bedding, at exercise or turnout, or pieces of wire. Other causes of penetration include sharp flint stones, pieces of glass, needles, splinters of wood, etc. Simple puncture wounds and nail pricks will result in hemorrhage into the sensitive tissues of the foot but depending on the size of the puncture there may or may not be signs of blood present on the solar surface of the foot.
The area of penetration of the sole is of great importance. If the nail is still in the wound, it is easy to see where the puncture actually occurred. Simple puncture wounds result in bruising and often secondary infection of the tissues and subsequent abscess formation, but deeper structures are usually not involved. The further away from the hoof wall that the puncture occurs, the higher the risk that the injury may have damaged the underlying pedal bone. In some cases this can cause a fracture of the pedal bone, but more often a small site of bone infection (osteomyelitis) develops that results in an area of bone erosion. A piece of infected bone may die, loose its blood supply and separate, forming what is called a sequestrum.
Puncture wounds towards the back of the foot, but away from the frog may result in infection of the softer cushioning structures deep to the frog, in the heal region, and may involve the digital cushion. These infections often result in extensive under-running of these structures at the back of the foot. The most serious foot wounds involve penetrations that occur in the back half of the foot, usually in the sulcus of the frog or through the frog. These may penetrate the navicular bursa and/or may involve the coffin joint. Infection established in either of these structures may result in damage to the deep digital flexor tendon where it runs over the lower surface of the navicular bone. This type of injury must be treated very seriously as it is potentially life-threatening.
What should I do if my horse has a puncture wound to the foot?
The first thing to do if you find a nail or piece of wire or glass in your horses foot is to pull it out so that the horse cannot tread on it again and cause deeper injury. The site of the puncture wound should be marked so that if further exploration is necessary it is possible to find its site again, especially if it is located in any part of the back three-quarters of the sole or frog. If it is not possible to remove the foreign body or if it is obvious that deeper structures are involved, your veterinarian should be called without delay.
If you are satisfied that the puncture is simple and uncomplicated, the sole and hoof wall should be cleaned and a poultice applied. If your horse becomes lame, typically within the next 24-48 hours, particularly if it becomes very lame, your veterinarian should be called as this is an indication that infection or damage to deeper structures has occurred. If the puncture wound involves the frog or the back half of the foot you should always call your veterinarian without delay. A clean dry bandage or a poultice should be applied while you are waiting for your veterinarian to arrive.
Will further treatment be necessary?
If infection has developed as a result of a nail puncture, this needs to be drained before it can be resolved. This involves cutting a hole into the sole to allow pus to drain out. Another poultice may help to 'draw' the infection through the hole. For a simple infection of the sensitive tissues under the sole, these measures are usually all that are required and the condition resolves quite quickly. After drainage is complete it may be necessary for the remaining hole in the sole to be packed, to prevent contamination and re-infection. 
Your veterinarian or blacksmith will advise you on the best material for packing the hole depending on its size, shape and site. If the infection does not resolve, a larger and deeper hole may need to be cut or other structures may become involved. Infections involving the pedal bone commonly cause a recurrence of lameness, requiring repeated drainage of the site of infection. These may be investigated by radiographic (x-ray) examinations.
If infection has become extensive and deep, it may be necessary for a large area of the sole to be cut away to allow complete drainage of pus and removal of damaged tissue. Long term or permanent resolution can only be achieved by cutting through the sole down onto the damaged area of the pedal bone and scraping away the damaged bone. This is a more complex procedure and necessitates the use of nerve blocks and the application of a special shoe to which a metal sole plate can be attached and detached so that dressings can be regularly changed and kept in place over a long period of time. This is often called a 'hospital plate'.
Puncture wounds to the navicular bursa require immediate surgical treatment to flush the navicular bursa and the coffin joint. This must be performed under general anesthesia and your horse may need to be referred to a specialist center for this treatment. Infections involving the soft tissue structures at the back of the foot may require extensive removal of damaged tissue and may require a long time for recovery.
Lameness caused by the development of infection typically occurs 24-48 hours after the puncture wound has occurred and characteristically tends to get worse rather than better over time, due to the accumulation of pus within the inelastic tissues of the hoof. If left untreated the horse's leg will begin to swell and you may find that pus tracks up the inner surface of the hoof wall and 'breaks out' at the coronary band. If this happens it may not be necessary to establish drainage at the sole, but it may help for the horse to receive antibiotic treatment to speed resolution of the infection.
If your horse is immediately quite lame after a puncture wound to the foot, you should call your veterinarian immediately because this will almost certainly indicate damage to the deeper structures.
Vaccination
Any wound can result in contamination with environmental bacteria, that may include Clostridium tetani, and your horse may develop tetanus. Puncture wounds to the foot are particular risks because they are contaminated with soil, that often contains the tetanus bacteria, that like to grow and produce their toxins in the air-less conditions of damaged tissues within the hoof. Every horse should be fully and regularly vaccinated against tetanus, to reduce the risk of this disease and avoid the worry that minor wounds may result in such unnecessary complications. Tetanus vaccine is initially administered on two occasions a month apart. A third vaccine is given at 12 months and booster vaccinations are given every 12 months. In most cases this vaccination regime can be combined with that for influenza and there are no excuses for not taking advantage of this life-saving vaccine. Please see our handout on Tetanus.
If an unvaccinated horse sustains a puncture wound, it is important to ask your veterinarian to administer a tetanus anti-toxin injection. Unlike a vaccine, this provides immediate temporary protection against tetanus, but does not provide long term immunity. Regular vaccination is by far the best policy.
FAQs
How do you treat a puncture wound on a horse's hoof? ›
To treat deep hoof puncture wounds, remove the foreign object, if it is still present, and debris from the puncture wound. This may involve surgery to clean and debride the wound. Horses who have sustained a deep puncture wound of the foot are treated with antibiotics to fight the likelihood of infection.
How do you treat a puncture wound on your foot? ›- Wash your hands. This helps prevent infection.
- Stop the bleeding. Apply gentle pressure with a clean bandage or cloth.
- Clean the wound. Rinse the wound with clear water for 5 to 10 minutes. ...
- Apply an antibiotic. ...
- Cover the wound. ...
- Change the dressing. ...
- Watch for signs of infection.
Puncture wounds are painful but the pain should subside as the wound heals. Over-the-counter medications can help with inflammation and pain. These include ibuprofen (Motrin, Advil) or naproxen sodium (Aleve). On average, it can take two days to two weeks for an injury to heal.
What is the most serious problem with a puncture wound? ›The main complication of an open wound is the risk for infection. Call your doctor immediately if you've had a puncture, deep laceration, or serious accident and you're showing signs of significant bleeding or infection. Signs of hemorrhage include continuous bleeding that doesn't respond to direct pressure.
How do you tell if a wound is infected on a horse? ›- Swelling: After an injury, damaged capillaries leak fluids into the surrounding soft tissues, while infection-fighting cells rush to the site. ...
- Odor: Any “off” or pungent odor coming from a wound, especially the oddly sweet smell of dead tissue, can be a sign of infection.
- Scrapes and Abrasions. ...
- Lacerations. ...
- Contusions. ...
- Puncture Wounds. ...
- Avoiding Wounds in Your Horse.
Call your doctor or nurse call line now or seek immediate medical care if: You have new pain, or your pain gets worse. The wound starts to bleed, and blood soaks through the bandage. Oozing small amounts of blood is normal.
Is hydrogen peroxide good for puncture wounds? ›Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the wound with a thin layer of petroleum jelly, such as Vaseline, and a non-stick bandage. Apply more petroleum jelly and replace the bandage as needed.
What is an example of a puncture wound? ›A puncture is a wound made by a pointed object such as a nail, knife, or sharp tooth. Puncture wounds often appear to be on the surface, but may extend into the deeper tissue layers. Stitches are primarily used if the cut is more that a quarter inch deep, is on the face, or reaches bone.
How do you make a puncture wound heal faster? ›Apply pressure to stop bleeding quickly and to prevent further anemia, and it may fasten the healing process. Cover the wound with absorbent materials such as sterile gauze pads (available over the counter), waterproof bandages, or a clean, dry cloth. Maintain pressure for one to five minutes.
Is swelling normal after puncture wound? ›
A puncture wound is a hole in the skin made by a sharp, pointed object. The area may be bruised or swollen. You may have bleeding, pain, or trouble moving the affected area.
How do you tell if a wound is healing or infected? ›Discharge - If the wound is discharging small amounts of pus, it is a positive sign of healing. However, if there is continuous drainage and you start noticing bad odor or have discoloration, the wound is likely infected. 4. Pain - Pain is a normal condition after sustaining an injury.
How long will a puncture wound hurt? ›What to Expect: Puncture wounds seal over in 1 to 2 hours. Pain should go away within 2 days.
What is the best antiseptic for open wounds? ›For more than a century, iodine has been regarded as one of the most efficacious antiseptic to reduce infectious complications and topical iodine forms have been used for wound treatment. The simplest form of iodine is Lugol's solution, which has irritating and caustic properties (18).
How long does it take to recover from stab wound? ›Follow-up care. Most skin wounds heal within 10 days. But even with proper treatment, a wound infection may occur. Check the wound daily for signs of infection listed below.
Is it better to cover wounds or leave open? ›Covering the wound maintains the natural moisture that helps keep cells alive. An exposed cut will pick up dirt and debris from the air. A wound that heals in a moist environment is less likely to leave a scar. An uncovered wound is more likely to be painful.
How long does it take for an open wound to heal on a horse? ›This usually takes 2-4 weeks depending on the size of the wound. During this period the wound is still susceptible to infection and the horse should be confined from moving around in a yard or stable, a bandage applied and antibiotics given.
When should I call the vet for a horse wound? ›Factors to consider when deciding if your horses' wound needs seen by a vet are both wound size and depth, amount of bleeding, if there is lameness associated with the wound, and importantly, the wound's proximity to any important structures such as a joint or eye.
How do puncture wounds heal? ›When you get a cut, scrape, or puncture, the wound will bleed. The blood will start to clot within a few minutes or less and stop the bleeding. The blood clots dry and form a scab, which protects the tissue underneath from germs.
How do you treat an open wound on a horse? ›Initial wound therapy involves cleaning debris from the wound with a cold hose and using dilute betadine solution to help disinfect the tissues. A compression bandage should be placed to stop any bleeding and keep the wound clean until your veterinarian can assess your horse.
Should you cover a horse wound? ›
If the wound is large or deep or there has been extensive bleeding your veterinarian should be called. While waiting for your veterinarian the wound should be left covered where possible. Wounds on the upper limbs, body and head, not amenable to bandaging, should just be cleaned and left open or continually cold-hosed.
Should you walk on a puncture wound? ›MEASURES YOU SHOULD TAKE TO HELP TREAT YOUR PUNCTURE WOUND: 1. Stay off your foot (avoid non-essential walking) as possible for 24 hours after the injury. Elevate the foot.
Should you let puncture wounds breathe? ›However, leaving a wound exposed to open air isn't required in order for sufficient oxygen to reach the wound. It is actually the oxygen transported by our blood that provides sufficient oxygen to the damaged blood vessels for the new skin cells to properly heal.
Which is better hydrogen peroxide or Betadine? ›Both the hydrogen peroxide and the Cinder Suds and Nitrotan were more specifically bactericidal for the P aeruginosa; that is, they were more effective at killing that bacterial type versus the S aureus. Betadine was equally effective against both bacteria.
What is the best antibiotic for puncture wound? ›For deeper contaminated wounds and delayed presentation in high-risk patients, broad-spectrum oral antibiotics are recommended such as amoxicillin/clavulanic acid, trimethoprim/sulfamethoxazole, or clindamycin with ciprofloxacin.
What are symptoms of a puncture wound? ›...
Symptoms
- Bleeding.
- Problems with function (movement) or feeling (numbness, tingling) below the wound site.
- Pain.
Sharp objects, such as nails, tacks, ice picks, knives, teeth, and needles, can all cause puncture wounds. Puncture wounds increase your risk of infection because they are hard to clean and provide a warm, moist place for bacteria to grow.
What promotes wound healing? ›Vitamin A, vitamin C and zinc help your body to repair tissue damage, fight infections, and keep your skin healthy. Try to eat foods from the lists below. Vitamin A is found in animal foods and some brightly coloured vegetables and fruits. Many vegetables and fruits are high in vitamin C.
Should you ice a puncture wound? ›Use ice for inflammation within the first 24 hours. Ice is best as soon after the injury as possible, but never during the activity. Personal preference. After 24 hours, using heat or cold therapy can be determined according to your preference.
What is considered a large wound? ›Although you can treat some wounds at home, you should see a doctor if: an open wound is deeper than 1/2 inch.
What are the 5 signs of infected wound? ›
- Pus. Pus or cloudy fluid is draining from the wound.
- Pimple. A pimple or yellow crust has formed on the wound.
- Soft Scab. The scab has increased in size.
- Red Area. Increasing redness occurs around the wound.
- Red Streak. ...
- More Pain. ...
- More Swelling. ...
- Swollen Node.
When germs get into the sensitive tissues beneath our skin via the cut, the cut may become infected. An infection can develop any time between two or three days after the cut occurred until it's visibly healed.
What are the 4 stages of wound healing? ›Wound healing is classically divided into 4 stages: (A) hemostasis, (B) inflammation, (C) proliferation, and (D) remodeling. Each stage is characterized by key molecular and cellular events and is coordinated by a host of secreted factors that are recognized and released by the cells of the wounding response.
Can you get a blood clot from a puncture wound? ›Stopping the bleeding (hemostasis).
When your skin is cut, scraped, or punctured, you usually start to bleed. Within minutes or even seconds, blood cells start to clump together and clot, protecting the wound and preventing further blood loss.
Rinse the area, gently, with clean water or isotonic saline solution, and apply a topical antiseptic. Use only a water-based product at this stage so your veterinarian can remove it easily, if necessary. If the hair is long, you may try clipping the area around the wound, if the horse will allow it.
What do you do if your horse has a nail in its hoof? ›If there is a nail or foreign object embedded in the hoof, the temptation is to pull it out, but if veterinary assistance can be called upon immediately, then leave the nail in place if possible so that the vet can see exactly where the wound entry is and determine the depth of the wound.
How do you treat an infected wound on a horse? ›Veterinary treatment may include trimming skin flaps, removing dirt and foreign particles from the wound, cleaning the wound with saline and antiseptics and suturing the wound if appropriate and bandaging. Use of antibiotics and pain relief may also be needed.
How long does it take for a cut to heal on a horse? ›This usually takes 2-4 weeks depending on the size of the wound. During this period the wound is still susceptible to infection and the horse should be confined from moving around in a yard or stable, a bandage applied and antibiotics given.