Answer:

Joe's sore foot requires some basic first aid, but probably less attention than most would think. A skinny puncture wound like this is hard to clean as the tissues close off the deeper portions. Definitely it needs to be cleaned with soap and water -- that's the single most important thing to do. But realize you are not going to get all the way into the wound. For that reason, too, soaking the foot is of little benefit. Antibacterial ointments may be used, but may not add much.

The biggest potential concern is an infection in the deep tissues of the foot. One type of bacterial infection is tetanus, an organism that produces a toxin that causes severe muscle spasms ("lock-jaw") and often death if it gets well established. Other types of more common bacteria (such as "staph") will cause nasty infections as well, but do not produce the dangerous toxin.

The goal then is to watch for signs of early infection. Using antibiotics prophylactically does not seem to help, so it's wait and see. Look for redness and swelling of the foot, increasing pain, drainage of pus, fevers and chills, or red streaks going up the leg. Elevate the foot, and keep from bearing weight as much as possible until the initial pain subsides. Anyone with conditions such as diabetes, or poor circulation to the feet, will be at higher risk for infection and should probably not wait to call the doctor.

If Joe received his initial three tetanus shot series, which are usually given in childhood, and has received a booster vaccination every ten years, then he's pretty well covered in terms of protection from lock-jaw. However, there may be very large and dirty wounds (such as major lacerations or injuries involving farm equipment) where an additional booster after only five years may be reasonable. For a puncture wound like this, waiting 48 to 72 hours before getting the tetanus booster is usually not a problem -- it will still work. So even if his tetanus shots are not up to date, Monday would be OK -- just don't forget!