It sounds like there might be a small abcess beneath the tough skin of the foot. This might have to be drained by a doctor or clinic nurse. Very painful to do without xylocaine.
If he had tetanus vaccine in the past 5 to 8 years it probably will protect him.
I concur, Doctor.
I’ve had very good results with amoxicillin/clavulanate for many decades now in outpatient medicine - specifically for foot puncture wounds with and without shoes (nails going through shoes I’ve used 875mg/125mg once daily for 5 days as prophylaxis, twice daily for 7-10 days for gross contamination, lacerations, etc. Ciprofloxacin is a good alternative, or has been for organisms mentioned including pseudomonads. The Sanford Guide is your friend… I’ve carried a copy since 1987 and I could read it without glasses).
From what the OP described, this does sound like a contaminated wound, not just simple “tattooing” from carbon or plant matter/dye.
Best care is I&D/debride as necessary, antibiotics and a Tetanus toxoid booster at least if not DTaP series for a child.
I’ve seen keflex work on C. tetani infection - patient had a skin “rash” from yard work, NP in my clinic Rx’d keflex and sent out a culture (thank God), turned out to be C. tetani and he had never had a vaccine but the wounds healed without complication.
Thank you. We’ll get him into a clinic tomorrow. A lot of the dirt trapped under the surface layer of skin left with the soaking. We plan to have him soak the foot again tomorrow.
I was looking for a sign of an abscess. But, he did not want me probing too much and I didn’t force the issue. If it were me, I would have suffered through it. But with him, nope, I didn’t even try.
We’re still reviewing our records to find a tetanus vaccination history.
Thank you for your advice. We’re following it and getting him to the clinic tomorrow.