Depending on when your last tetanus shot was, a doctor may recommend getting a booster shot within 48 hours of a nail puncturing your skin, especially if the nail was dirty.

Stepping on a nail can be a painful experience. Depending on the severity of the injury, the nail can puncture a hole deep in the sole of your foot. This can make it difficult to walk or stand for a few days.

Once the shock of an injury wears off, it’s important to take immediate steps to care for your wound. These punctures may be treatable at home, but some wounds may require medical attention.

Here’s a look at how to care for a nail puncture wound, as well as what symptoms mean you may need to see a doctor.

Prompt treatment after a nail puncture can speed the healing process and prevent an infection:

1. Wash your hands

Wash your hands before caring for any type of wound. Germs like bacteria could enter your body through a wound.

Clean hands with warm soapy water for at least 20 seconds. This is the equivalent of singing the Happy Birthday song twice. Dry your hands with a clean cloth.

2. Stop the bleeding

Some nail punctures bleed, some don’t. If bleeding occurs, apply gentle pressure to stop bleeding and promote clotting. Be gentle: Too much pressure can worsen pain and bleeding.

3. Clean your wound

A nail on the ground may contain bacteria or other germs that can make you sick, especially if it’s dirty or covered in rust. Cleaning your wound is one of the best ways to prevent complications like tetanus, a serious bacterial infection. The bacteria that causes tetanus can be found in dirt, dust, or animal feces.

To properly clean a puncture wound, start by rinsing the injury with clean water for about 5 to 10 minutes. This helps remove dirt and any lose debris.

Debris can include dirt or pieces of fabric from your sock. If necessary, use tweezers to remove debris from your wound. Clean the tweezers with rubbing alcohol beforehand.

Also, gently clean the skin around your wound with soap, water, and a washcloth.

4. Apply antibiotic cream

Cleaning is important but it’s not enough. You should also protect the puncture to prevent an infection. After cleaning and drying your wound, apply a thin layer of a topical antibiotic cream such as Neosporin.

5. Cover your wound

It can take several days for your wound to heal. During this time, wrap it in a bandage to protect and keep it clean. Change your bandages at least once a day, preferably after showering. Wait until any bleeding stops before applying a bandage.

A minor nail puncture may not require a visit to your doctor. But, if the nail or wound was dirty or the puncture is deep, you should see your doctor or visit urgent care. They’ll likely give you a tetanus booster shot if you haven’t had one in the past 5 years.

Regardless of the type of puncture wound, if you can’t remember when you had your last tetanus booster shot or it’s been over 10 years, you should see your doctor for a tetanus booster. When necessary, you should get the shot within 48 hours after your injury.

Don’t downplay the importance of getting an updated tetanus booster after stepping on a nail. This is especially important if your injury occurred outdoors in soil or if you believe the nail was contaminated.

A tetanus infection affects the nervous system and can be life-threatening. Since there’s no cure for tetanus, you should take every possible measure to avoid this infection.

Signs of tetanus include:

  • spasms and stiffness in jaw muscles
  • neck stiffness
  • difficulty swallowing
  • stiff abdominal muscles
  • body spasms lasting for several minutes

Even if a wound doesn’t progress to tetanus, it can still become infected.

After cleaning and applying antibiotic ointment, monitor the wound over the next couple of days for signs of complications.

A skin infection can develop as early as two days after stepping on a nail. If the injury causes a joint or bone infection, symptoms can appear within 14 days after the injury.

Signs of an infection include:

  • increased soreness
  • warmth and redness
  • swelling
  • discharge from the wound
  • fever or chills

See a doctor if you develop any of these symptoms. You should also see a doctor if:

  • you’re unable to control bleeding
  • you’re unable to remove a foreign object from your wound
  • you suspect bone damage from a deep puncture

Your doctor can order an imaging study to further examine your foot to determine if an object is still in your skin or if there’s bone damage.

Complications from stepping on a nail can be serious. But with prompt at-home care and early medical treatment for signs of an infection, the outcome is positive and your wound should heal well. You may have scarring depending on the depth of the puncture.

There’s also a lower risk for developing tetanus if you’re up-to-date on your booster shot or if you get a booster shot within 48 hours after your injury.

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. Recovery time is based on the depth of the puncture.