Stepped on a Nail

by Marissa
(Texas)

I stepped on a nail about 10 weeks ago (with a sock and shoe on). It went right into the center of my heel. I was up to date on my tetanus booster, so I just soaked it, applied Neosporin and called it a day.

After I'd been limping for 8 weeks, I visited a podiatrist, who took xrays and didn't see anything abnormal. The skin was completely healed and no signs of infection, but she put me on an antibiotic to be sure. She scraped off a bit of callous that had formed over the area. She also tested me for plantar fasciitis, which I did not have.

It didn't feel any better after antibiotics, so I went back and have now been in a boot for about a week to take some of the pressure off the heel. I don't really feel like I'm making much improvement, if any.

The heel is achy when resting. When walking barefoot or with hard-soled shoes, it can feel like I'm stepping on something sharp. With tennis shoes, it feels more like a walking on a bruise.

I'm tired of limping. What could be causing the pain, and how can I fix it?

RESPONSE

Hi Marissa,

Reading your narrative, I have to believe you must have come down with some force for the nail to go through your shoe and break the skin on your heel.

The first thing one might think of is the possibility of a bone infection, bacterial in nature, which could occur from a nail. (tetanus has nothing to do with this). But, the good news is that if that were the case, at eight weeks something would have shown up on x-ray. Additionally, your heel would have been red, hot and very tender. There is also the possibility that your open wound would have never closed.

So, what does that leave us with?

My first thought would be that of a bone bruise, meaning the nail just damaged the heel bone without actually breaking it or creating an infection. The problem with this location is that every time you walk on it, you are essentially re-injuring it, so it never has a chance to improve. I am guessing here that the more you walk on the heel, the more it hurts as opposed to plantar fasciitis which tends to hurt more when you first step on the heel and then eases up as you walk.

Your podiatrist has the right idea in trying to limit the pressure on the heel by putting you in a boot. I am not sure that is the best option.

Assuming it is a bone bruise and nothing more, (an MRI would tell you if you punctured the plantar fascial ligament or did some other sort of damage) then I would consider another device to reduce the pain.

That would be the use of a egg shell heel cup. What this does is compress all fat in the heel to the bottom portion of the heel. By doing so it creates more of a cushion. That is why for example, you feel somewhat better in a sneaker then you do barefoot or in regular shoes, simply because the sneaker adds some cushioning to the heel.

To test the concept, if you grasp your heel on the outside, back portion and inside borders of the heel with one hand and squeeze, this will force the heel fat more underneath the heel. With your other hand, if you then press on the bottom of the heel, you should feel far less pain.

If this is what you end up experiencing, then you should consider an egg shell heel cup also known as a plastic heel cup. We have them here on our site, and you can possibly purchase them elsewhere.

Keep in mind, this problem will still take time to heal, as stated previously, walking on it just keeps aggravating it.

Marc Mitnick DPM
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