How do I know if the wound on my shin is infected?

Contact your provider right away for redness, increased pain, yellow or green pus, excessive clear fluid, or black edges around the wound. It also helps to know what kind of leg wound it is, since a venous leg may already be warm and discolored while an arterial one may be pale and cool.

Start with a limit, because it shapes everything below. There’s no warning-sign list just for the shin. Pressure sores form over bony sites such as the buttocks, elbows, hips, heels, ankles, shoulders, back and back of the head. Venous ulcers usually form on the leg above the ankle. Ulcers from poor blood flow show up on legs, ankles, toes and between toes.

What applies instead is the general list. Contact your provider right away for redness, increased pain, or yellow or green pus, or excessive clear fluid around the injury. These are signs of infection. Also contact your provider right away for black edges around the injury. This is a sign of dead tissue.

The more useful question on a shin is what kind of wound it is, because the specific signs differ in ways that change how you read them. With a venous leg, the skin around the wound may be shiny, tight, warm, or hot, and discolored before any infection — so warmth tells you less there. A leg with poor arterial flow may be pale and cool, and turn red when hung down. A wound from a knock or a scrape on an otherwise healthy leg has neither baseline, so ordinary redness and warmth mean more.

So the thing to work out is which leg you have. Early signs of venous insufficiency include leg swelling, heaviness, and cramping, and dark red, purple, brown, hardened skin (this is a sign that blood is pooling). The arterial picture is the opposite: a foot that is cool to the touch, pale or blue, with pain that may go away when the leg is dangled down.

One general benchmark applies whatever the cause. A wound is called non-healing if it has not started to heal in 2 weeks or has not completely healed in 6 weeks. A shin wound that has passed either mark is worth a proper look, whether or not it seems infected right now.

What to watch for

Contact your provider right away if you have redness, increased pain, or yellow or green pus, or excessive clear fluid around the injury; black edges around the injury, which is a sign of dead tissue; bleeding that will not stop after 10 minutes of direct pressure; fever of 100°F (37.7°C) or higher for more than 4 hours; pain at the wound that will not go away, even after taking pain medicine; or a wound that has come open or the stitches or staples have come out too soon.

Because there’s no list just for this spot, describe the whole leg, not only the wound, when you call. Say whether the leg is swollen or heavy, what color the skin is above and below the wound, whether the foot is warm or cool compared with the other one, and how the wound started. Those details let someone decide which list actually applies to you.

What we look at

  • What kind of wound this is, and what established it
  • Whether the leg shows signs of venous insufficiency or arterial disease
  • Which infection signs are present, and when each appeared
  • Whether the 2-week or 6-week non-healing marks have passed
  • Whether anything is rubbing or knocking the shin repeatedly

Sources

  1. MedlinePlus — How wounds heal: https://medlineplus.gov/ency/patientinstructions/000741.htm
  2. MedlinePlus — Venous ulcers, self-care: https://medlineplus.gov/ency/patientinstructions/000744.htm
  3. MedlinePlus — Ischemic ulcers, self-care: https://medlineplus.gov/ency/patientinstructions/000742.htm
  4. MedlinePlus — Wound care centers: https://medlineplus.gov/ency/patientinstructions/000739.htm