Stingray Envenomation of the Foot: A case report

by Al Kline, DPM1

The Foot & Ankle Journal 1 (6): 4

Stingrays are docile marine animals that only strike their victim when provoked or startled. Lower extremity and foot envenomation is common when fishing in shallow waters off the beach. The stingray tail has a sharp, serrated barb along the proximal third of the tail that is usually hidden and encased in an integumentary sheath and can deliver painful enzymes causing tissue necrosis. Immediate treatment including rapid cleansing and heat submersion of the foot is recommended after injury. If treatment is delayed, infection from marine bacteria often requires hospitalization including intravenous antibiotics and surgical treatment.

Key words: Stingray envenomation

This is an Open Access article distributed under the terms of the Creative Commons Attribution License.  It permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ©The Foot & Ankle Journal (www.faoj.org)

Accepted: May 2008
Published: June 2008

ISSN 1941-6806
doi: 10.3827/faoj.2008.0106.0004

Stingray envenomation of the foot is a common marine injury. There is an estimated 1500 stingray injuries reported annually in the United States. [1] Usually, a person will be fishing in shallow water and accidentally step on the stingray. This causes an instinctive, defense mechanism of the stingray. The tail will lash upward like a scorpion and penetrate a sharp bard in the lower extremity or foot. The stingray tail has a sharp, serrated barb along the proximal third of the tail that is usually hidden and encased in an integumentary sheath. The stinger barb is made of cartilage and the serrations are directed proximally.

This means, that as the barb penetrates, the barb can rip tissue or even lacerate tendons, ligaments and other soft tissue as it pulls away from the puncture site. (Fig. 1) The integumentary sheath that encases the barb also contains a venomous protein that is released into a wound when the barb strikes and the sheath ruptures. This will cause intense pain and tissue necrosis. The barb can remain or break off in the wound. Fortunately, this only occurs in about 5% of reported cases. [2,6]

Figure 1  The serrated stingray barb.  The barb is encased in an integumentary sheath.  The serrated spines are directed proximally and can cause extensive tissue damage when pulled from a wound.

Envenomation occurs in up to 75% of reported stingray injuries. [6] The stingray venom contains the neurotransmitter serotonin and two enzymes; 5-nucleotidase, and phosphodiesterase. [2] Serotonin is responsible for the intense pain associated with the sting and the 5-nucleotidase and phosphodiesterase enzymes cause intense tissue necrosis.

Fatal envenomation is extremely rare and has recently come to light due to the death of “The Crocodile Hunter”, Steve Irwin, on September 4th, 2006. Steve Irwin was snorkeling in water and swam close to an Australian bull ray. (Fig. 2) The ray was startled and lashed its tail upward and pierced Steve Irwin’s heart. He died shortly after pulling the barb from his chest. It was reported at that time that only three fatal envenomations in Australia’s history had been reported before Irwin’s death.

Figure 2   The Australian bull ray or Southern eagle ray (Myliobatis australis).

Interestingly, one month later in October 2006, James Bertikas from Florida was stung by a ray as the barb also pierced his heart. However, he did not remove the barb, and survived his injury. In his case, a 2 ½ inch barb penetrated his left lung and migrated into his heart crossing both the left and right ventricle. [8] Most deaths occur from the actual laceration of a major artery or organ such as the heart from the barb and not the venomous effects.

However, in one report, a 12 year old boy died after envenomation from a freak accident when an ‘airborne’ ray slammed against his chest penetrating the barb into the boys left lung and piercing the pericardium.

The boy was relatively asymptomatic and initially treated for a puncture wound to the chest and knee, but he died six days later from sequestered venom and myocardial necrosis causing right ventricular rupture and fatal cardiac tamponade. [2,6] Another reported case involved a man who sustained a laceration to his femoral artery and bled to death. [2] In most cases, stingray injuries are not life-threatening, but can cause long-term complications. In one report, osteomyelitis of the malleolus resulted from an ankle strike seven months after injury. [6]

The effects of envenomation are not clearly understood as to reported systemic effects. Common reported symptoms can include diaphoresis, nausea, cardiac arrhythmias,tremors, skin rash, headache,delirium, fever, hypertension, syncope, anxiety and a host of other common allergic reactions.

Another complication from injury is the seawater and bacteria that can enter a wound on penetration during this injury.

We present the case of a 31 year old male who stepped on a stingray while fishing. He delayed initial treatment, continued to fish and developed cellulitis with a painful foot which required hospitalization and surgical treatment.

Case Report

A 31 year-old male presented to the emergency room with a hot, swollen foot. He was fishing in shallow water the day before and was stung by a stingray. He felt a sharp pain to the top of his foot. He continued to fish most of the day. In the evening, his foot swelling and pain got progressively worse. His wife went to the internet and realized that submerging the foot in hot water would eliminate the pain. He submerged the foot in water and his pain dissipated that evening. In the morning, he had a progressive increase in pain and presented to the emergency room for treatment.

Clinical evaluation revealed a small puncture wound to the dorsolateral aspect of the right foot. (Fig. 3) There was increased soft tissue swelling with slight tissue crepitus. His laboratory data revealed a 16,000 white count with a left shift. Routine radiographic evaluation showed an area of gas in the region of the puncture wound, but no sign of barb. (Fig. 4)

Figure 3   A small puncture wound is see to the dorsolateral aspect of the foot consistent with a stingray envenomation.  The central puncture wound will have signs of tissue necrosis.

Figure 4   Radiographic evaluation reveals soft tissue gas formation in the subcutaneous tissues of the dorsal foot.  No barb is seen on radiograph.

It was recommended he go directly to the operating room for incision and drainage with exploration of the wound.

Surgical exploration revealed soft tissue necrosis through the subcutaneous layer from the initial envenomation. All soft tissue was removed and sent for deep tissue culture. Some local debris was flushed from the wound, but no barb was located. The wound was thoroughly irrigated with Betadine solution and Bacitracin irrigation. The wound was then loosely packed and the edges of the incision were loosely approximated. (Fig. 5)

Figure 5    It is important to open the puncture site and remove any necrotic tissue and explore for foreign material that may cause continued infection.  Necrotic tissue is removed, the edges of the wound can be loosely approximated and the central injury point may granulate and heal by secondary intention.

Tissue cultures revealed Staphylococcus aureus. He was placed on IV Levaquin. His initial infection took about a week to resolve and he was discharged from the hospital. He continued local wound care and within 2 weeks of his injury, the wound closed. (Fig. 6)

Figure 6  The wound is now closed and the patient has returned to work without incident.

Discussion

It is important to initially submerge the foot into hot water after the incident. Rapid application of heat will denature the enzymes causing the pain and limit the effects of tissue necrosis. It is recommended that immediate submersion into hot, but not scalding, water will also help to ease the pain of this injury.

It is recommended to submerge the foot into a water temperature of 42 to 45 degrees Celsius (108-113 degrees Fahrenheit) for 30 to 90 minutes, or until the pain resolves. [3] Infection of the wound can usually be avoided with aggressive wound cleansing and oral antibiotics.

In cases where cellulites results in delayed treatment or is not responsive to oral antibiotics, hospitalization and intravenous antibiotics is recommended. The most common pathogens to infect the wound include Staphylococcus aureus and streptococcus species. Water-borne pathogens of concern include Vibrios vulnificans in salt water and Aeromonas species in fresh water.

In more serious lacerations, it is important to immediately control hemorrhage from the laceration by applying direct pressure to the wound. Applying a tourniquet to the extremity is not recommended because swelling and systemic effects are rare in extremity wounds. [2] The wound should always be cleansed thoroughly with an antibacterial wound cleanser immediately after injury. Hexachlorophene in 70% alcohol (pHisoHex®) or Betadine solution will provide good antibacterial cleansing of the wound. [6]

Although there is no antidote or anti-venom , it has also been reported that direct injection of 1% lignocaine (or lidocaine) may have an anti-venomous affect to the venom that remains in the wound. [6] If the patient presents some time after injury to the emergency room with a hot, swollen foot, it is important to incise and open the puncture site, even if no barb is present. Intravenous antibiotic therapy is recommended until the cellulites has resolved. Hyperbaric oxygen in the treatment of stingray envenomation has also proved to be beneficial. [4]

Tetanus prophylaxis should also be current. Levofloxin or Levaquin is the drug of choice against Vibrio species and will cover Staphylococcus aureus and multi-drug, gram-negative organisms common to penetration injuries. Bactrim and Doxycyline are also good against Vibrio species, although the coverage is not as good for staph and strep species. [3]

Of course, antibiotic treatment can be tailored to the results of deep tissue samples taken at time of surgery to determine the infective organism. At time of surgery, it is recommended to inspect the wound for foreign material, remove any necrotic tissue, take deep tissue biopsy for culture and leave the wound packed open. Packing can include Betadine gauze or calcium alginate. Calcium alginate dressing or Kaltostat® has been reported to absorb toxin in one report. [7]

Conclusion

Stingrays belong the the class Chondrichthyes meaning cartilaginous fishes. These are usually docile creatures that only strike when provoked or feel threatened. In this case, medical treatment after initial injury was delayed which required surgical treatment and prolonged hospitalization. The delay in initial treatment caused progressive tissue necrosis and secondary infection after injury.

It is important to treat these injuries promptly. If the injury is not life-threatening, it is important to quickly cleanse the wound and submerge the foot in hot water to deactivate the tissue enzymes that cause pain and tissue necrosis. Ideally, medical treatment will consist of radiographs to eliminate the possibility of a barb that may remain in the wound. In the emergency room setting, the wound can be injected with 1% lidocaine and lanced at the puncture site. The wound should then be aggressively irrigated with Betadine. A calcium alginate dressing can then be applied to the open wound and allowed to heal by secondary intention. Oral antibiotics with coverage for gram positive and negative organisms are prescribed at discharge.

References

1. Perkins, A.R., Morgan, S.S.: Poisoning, Envenomation and Trauma from Marine Creatures. American Family Physician, February, 2004 [Online]

2. Ganard, S. Stingray Injuries, Envenomation, and Medical Mangement. [Online article]

3. Meade, J.L. Stingray Envenomations, Emedicine article [Online]

4. Rocca, A.F. Hyperbaric Oxygen Therapy in the treatment of soft tissue necrosis resulting from a stingray puncture wound. Foot Ankle Int. 22 (4): 318-323, April 2001. [PubMed]

5. Perkins, A.R., Morgan, S.S.: Poisoning, Envenomation and Trauma from Marine Creatures. American Family Physician, February, 2004 [Online]

6. Fenner, P.J. et al: Fatal and Non-Fatal Stingray Envenomation. Med Journal Australia : 151:621-625. 1989. [PDF]

7. Fenner, P.J.: Stingray Envenomation: A Suggested New Treatment. Med Journal Australia: 163: 665. 1995 [PDF]

8. St. Petersburg Times [Online news wire], October, 2006.


Address correspondence to: Dr. Al Kline, DPM, 3130 South Alameda, Corpus Christi, Texas 78404. E-mail: al@kline.net

1Adjunct Clinical Faculty, Barry University School of Podiatric Medicine. Private practice, Chief of Podiatry, Doctors Regional Medical Center. Corpus Christi, Texas, 78411.

© The Foot & Ankle Journal, 2008

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94 responses to “Stingray Envenomation of the Foot: A case report

  1. Yo Al-
    Loved the piece. As I am a frequent surf fisher this is of great interest to me.

  2. Very interesting facts since my better half is now undergoing medical treatment for a sting on the side of her foot! The scratch 1 inch away is now the problem as it has blistered and may now be nercrotic! In Huatulco her foot was not submersed in hot water at all but was flushed with peroxide, administered a pain releif about 45 min, later and antibiotics administered twice daily with pills in addition for the weeks stay. Now she is on IV drip for administering antibiotics here and samples of the tissue and blood are going to tell the rest of the story, and I hope it is for the best!

  3. It should be noted that the StingRay was aggresive in its attempt to sting Cathy! I have not found any evidence to suggest that they will attack but if startled will swim or sting! This Ray appeared to keep coming after Cathy and while she was avoiding the other Rays in the shallows it managed to sting her! Is this a breeding time or something where it was protecting young? It did happen to be near where a river/drainage outlet was situated from a sewage treatment plant which may explain warmer water and the abundance of these Rays there?
    The treatment seems unsuccessful with the wound and area becoming sorer! The real culprit to all this may have been contamination in the water that entered the scratch as the penetration wound has all but healed, The docters may be treating for the wrong thing! Time will tell if time doesn’t make it worse to the point that the onset of the infection calls for more tissue removal!

    • We have a local stingray sanctuary at our Aquarium. I suspect that rays are very territorial. I have seen this type of behavior when rays are in groups.

  4. I go to surgery thursday for a stingray attack that occurred on 4/13/09 while I was on vacation. It was not cleaned at all in the er, I was put on doxycycline and given a tetanus shot. I went to the er where I live on 4/16/09. It was obviously infected. I was put on bactrim ds. The wound was not opened and cleaned. I have some pretty gnarly pics. The barb went through my leg right above my ankle and then back out. After the incision and debridement the doc told me a skin graft will have to be done because you can see the tendon (the sheath has partially liquified) and the muscles. the hole is too big to close itself. aaarrrrggghhh. I am SO tired of this.

    • Stacy….I’ve been going through this since July 9th…and AAARRGG too!!! It got me in my leg and then thru my wrist too. My wrist is healed very well, but my leg, Im getting ready to go thru my second surgery next Wednesday. The first was a debridement and I have been wearing a wound vac for last 3 weeks without any healing noted. I am going for a skin graft next Wednesday. Then I have to wear the wound vac for 2 more weeks to get it to heal faster. BTW: the wound vac is about $165/day. So all my hospital bills are adding up. SO ready to get back to work. Hope you get better.

  5. Stacy,

    Sorry to hear of your ordeal. Feel free to post your photos with us. You can send your pictures JPEG files to picomstaff@hotmail.com. I’ll then upload them to this page. Keep us informed on your outcome.

    • Well, I went to the or today. The dr said that the tendon that moves my foot sideways (didn’t say the name, anyone know?) was dead and he had to remove it. He was very upset that it had never been debrided and says that is why the tendon died and the healing was so delayed. I am 100% non weight bearing at this time so it can heal. I go back to the wound care center tomorrow so they can check it. He said I will still need a skin graft. stay tuned……

  6. I have posted Stacy’s pictures of her injury. Feel free to comment here on what you think. Could this have been managed differently?

    Stingray Injury Picture #1
    Stingray Injury Picture #2
    Stingray Injury Picture #3
    Stingray Injury Picture #4
    Stingray Injury Picture #5

  7. I must say the 5th picture looks much better! Needless to say, it’s pretty obvious that the following should have happened:

    1. Heat submersion after initial injury-immediate trip to hospital ER for admission.
    2. Immediate incision and drainage with aggressive debridement after injury. Open packing of injury with Calcium alginate or betadine solution soaked gauze. (This type of penetration injury should be opened from entry point to exit point)
    3. Hospitalization (outpatient treatment of such an injury on oral antibiotics just won’t do it for this type of injury)
    4. IV antibiotics
    5. Sometimes these deep, muscular injuries require a secondary operation to remove additional necrotic tissue.
    6. Whirlpool, wound care and hyperbarics also have indications in treatment.

    • How long should a wound go before it needs hyperbarics/advanced treatment? I was stung 6 weeks ago and weekly ‘debridement’ seems to reopen the wound/deepening it so any advances in healing or the laceration getting smaller seems futile. The wound actually looks deeper today after debridement than it did the day it happened. Mine is a laceration across the top of the foot because I was swimming in shallow water above the stingray, not walking, when it happened, apparently too close. I’ve been to 3 docs, the 2nd one removed a barb after it had gone undetected for 2 weeks. I had no idea it would take this long and am shocked to see everyone’s stories!!

  8. I went to the wound care center for the first post-surgery exam yesterday. The tentative plan is to put a wound vac on it as soon as possible and to maybe go back to surgery next thursday so they can attempt to close the wound. They will probably still have to do a skin graft at some point. I have already missed a month of work, and have a ways to go. I am a prison guard, so there are no “light duty” assignments. I cannot go back to work until I am cleared to be on my feet for 16 hours. This is killing me financially. I am also a very active person, so the cabin fever is driving me nuts! All this from a fish… I advise anyone to research what should be done for an injury and be very proactive and assertive so you do not wind up where I did. This could have been prevented.
    Thank you, Stacy Williams

    • Liam O'Sullivan

      Stacy all the best, it took me two months to find the right antibiotics and the right Doctor who knew how to fix my injury. A suggestion and what really worked for me was splashing warm salty water over my wound, letting the area dry and then wrapping my wound up. And staying off the foot for at least ten days..9 months later my healed wound still gets itchy sometimes..but good luck I hope it heals up real quick.

  9. Al-
    Stacy is my mom and I was there when It happened. She was is HORRIBLE PAIN for about an hour and a half untill the nurse gave her some kind of pain relief. Thanks for all the advise and I dont see a vacation to the beach any time soon.

  10. I went to the Dr. yesterday and I am scheduled for a skin graft next Thursday 5/21/09. Wish me luck…

  11. GL, take some photos!

    • stacy williams

      Just thought I would update you. I had the skin graft on 5/21 as scheduled. No pictures of that because there was a compression dressing that stayed on for a week at a time and was changed at the docs. On june 18 was was given permission to put limited weight on the foot for balance and tranfers. On the 25th, I was told I could put weight on it as tolerated. I started physical therapy last week and saturday 7/4 was my first day crutch-free. Last Thursday they finally took the dreesing off permanently. I will get some pics and send them to you. I am hoping to go back to work next week, although I don’t know how well the 16 hours totally on my feet is going to go. It was the tibialis anterior tendon that had to partially be removed and I have problems picking my foot up correctly. The stairs at work should be loads of fun…..anyway, I’m hoping this adventure is almost over! Thank You, stacy

  12. Dr. Kline,
    My son was stung by what we believe to be a stingray on May 16, 2009 at Gulf Shores, AL. Pain was immediate and bled freely. Initial thought was jellyfish having never been stung by anything at the beach before. He drove back to Birmingham the following morning but swelling and redness increased and sooght treatment at ER. Placed on oral Levaquin and went home. Next morning redness and swelling had continued higher and admitted to hospital. Placed on IV antibiotics for 7 days. Checked out of hospital on 750 mg oral Levaquin 1/day and 100 mg doxycycline 2/day. Changing dressing every 12 hrs. Concerned if additional treatment needs to occur. Being monitored by plastic surgeon. I will send pictures. Please give feedback ASAP.

  13. I got hit while gigging flounder 05-25-09 on my left ankle . It hurt. Got back to boat , squeezed the wound and flushed with peroxide and packed with neosporin. 45 minutes later I had it in hot water. Pain subsided immediately. It oozed for a few days on the 3 day it was beginning to get warm. And I thought I was about to get infected. It cooled off and started to heal. It has been 3 weeks today and it is almost closed up, for 1 ” gash to a 1/4″ . There is still swelling but it subsides if I elevate it. The skin feels hard around the wound but it doesnt hurt. The swilling is going away. I feel fortunate I didnt get any other infection.

    • Dear Mike,
      I hope that your stingray injury healed without
      additional unpleasant incident. My wife has a
      got stung one week ago, and has similar developments,
      as you described. She now has severe itching around the wound site.

      Please let me know if you needed additional treatment or not.

      Stephen

  14. I got stung in my knee while diving and taking care of some students. The students startled the ray but I was the one who got hit. I’m thankful for that as they were only 12 years old! I got quite a fright and I’ve never experienced so much pain before. I went straight to the hospital. The doctor injected me with local anesthetic and thoroughly flushed the wound with betadine solution. The had a poke around to see if there was any debris, but none seemed to be visible. They inserted a piece of gauze to stop the wound healing, then dressed it up and told me to go back the next day. I’m on 2000 mg amoxicillin daily and they told me not to walk on it unnecessarily. It’s now been almost 48 hours and I have no pain, a little swelling and feel some tightness around my knee area. I do have to say that I am a little worried about this tissue necrosis. But, I am sure that some pain or discoloration of my skin would be evident by now. I’m keeping my fingers crossed that all will be well.

  15. i was stung on 8/8/09 on the side of my foot by what i’m guessing was a very small sting ray. we called the local EMS, and they took vitals and told me to go home and soak it in hot water and clean it and it should be fine. they also recommended i get a tetanus shot, but i have not done so yet. my sting was completely painless the following day and the day after. then i had to get into a really hot car for about 30 minutes (104 degrees) and suddenly my ankle opposite of where i got stung and my calf swelled up. i have some very tender streaks going up my shin and from the swollen ankle, but the ankle itself is not red or painful. the swelling in my calf has gone down quite a bit, but i am concerned about the pain that i am having in my leg. i cannot put any weight on my leg or it feels as though someone is shoving a tiny cactus up the inside of my leg in those two tender areas. should i go to the ER? i live in a small town way away from the ocean, and i am just afraid that these doctors around here will have no idea what to do about this.

    • Kelly – The streaks could be a sign of infection. I’d recommend going to the nearest metropolitan area for help. I live in somewhat small town 2 hours south of Washington, DC and had to go to the DC metro area to get help. Doctors in my area have bad reputations, but even the doctors at the beach told me I was fine. Now I’m spending a lot of time going to appointments with a plastic surgeon that is cutting open the wound to drain it frequently and I will need a skin graft because of dead tissue.

      • Hi Everyone – I thought I’d post an update about my ankle. I got stung on August 2 this year on the inside of my left ankle and ended up needed a lot of visits to a reconstructive surgeon because a lot of skin/tissue around my sting died (turned dark purple and the sting was about 3/4 inch deep so once a thin scab covered that some damage was damage was also done internally due to the venom and the sting also punctured a tendon). I did go to a doctor at the beach, got a tetanus shot, xray, poured hot water over it (looking back, maybe not hot enough or should have submerged my ankle). Also went for a second visit and was told I was fine. It’s been almost 5 months now and I have received three skin grafts so the wound is finally covered but still not filled in (the area still dips in) and the grafted area is still purple. I still have mild pain (like a twisted ankle) and some swelling, but the surgeon said that could last a year. I can walk better and am hoping to ease back into exercising, but it’s been a long process. From reading online and talking to doctors, it sounds like my case was more severe than a lot. I’m not sure what improvement to initial treatment would have helped things, but 10 days after the sting I woke up with extreme pain and could barely stand to walk. The swelling was worse than I’d ever seen from sports injuries and the purple area (dead tissue though I didn’t know it and a doctor told me it was normal/a bruise) was maybe the size of the bottom of a soda can.

  16. another thing: does the venom get into your bloodstream or stay localized? i am pregnant and pretty concerned about the effects this might have on the baby.

  17. I also had an issue with neglect from doctors (no draining/debridement or hint that it might be needed; was told I was healing fine when I was concerned). Long story short, I had to go to a plastic surgeon Thursday, Friday and Monday (today is Tuesday) and my next appointment is Friday. I will need a skin graft as well.

    A couple of questions:

    – What’s the healing process for a skin graft on the ankle? I know the dressing stays on for awhile and is changed by the doctor, but can I walk on it? What sort of bandage or dressing should I expect? How long will it require me to take off work?

    – Has anyone ever sought legal action for neglect from an emergency medical place? I went to the same place twice (day of sting and four days later – two different doctors). It was never drained or debrided thoroughly and at the second visit I was told I was fine when I was concerned (already showing the symptoms that six days later sent me to doctor in the DC area and then a surgeon).

    Also, I posted a recount of what happened to me on my blog (though with an online medical information twist – I’m a web developer) if anyone is interested: http://blog.erinmstewart.com/2009/08/18/stingray-sting-and-online-medical-information/

  18. Hello,

    I was hit with a stingray on 9/21/09 while on Ocracoke Island in North Carolina. I did go immediately to a physician there and he advised me to soak my foot in extremely hot water to help with the pain. I spent two hours in the office soaking my foot and also soaked it another hour after I left there. I also received a tetanus shot that day. After three weeks now, I was thinking that things were going to be okay with it, but it does have a swollen spot there where I was hit. I am wondering if this is normal or will I need to get it checked and have it drained? Any info would be helpful!

    Kristen

    • hi kristen. i don’t know how big the stingray was that got you, but i got hit by a small one, and it DID swell, but i just kept soaking it. it never showed real signs of infection or anything, but it did swell right at the injection site. i saw a doctor about it, and he prescribed me some antibiotics, but he didn’t even LOOK at it, so i didn’t take them. anywya, after about a month it healed up just fine. i would watch out for redness that spreads, swelling that is more than just at the injection site, or streaks coming from it. those are all signs of an infection. otherwise, i would not worry about it too much.

  19. I originally posted in March 09 about my better halfs envenomation…to this day there is still an odd dark colour below the injury site. If you apply pressure on top of the spot it seems to puff up slightly. I have not received anymore flak in some months accusing me of trying to scare away tourists!!! Thankgod and I hope I have raised some awarness of the situation arising from a stingray sting, and what seems like a form of ignorance from the medical field when it comes to treating these things…by the way my better half also happens to be a Nurse. A bandage process called wet to day on the area after debridement of the wound will help greatly…

  20. Thanks for the input Cliff. It helps to know that I may be dealing with this for some time so I guess I won’t think that my foot will fall off any time soon. I sure do agree with you that unfortunately for whatever reason the medical field does not have much after treatment care. I do not live near the ocean and if I were to see a local doctor, they would have no idea how to provide post-treatment. Don’t worry about the flack of scaring the tourists away, because had I been made aware of the darn things being so close to the edge of the water, it would not have kept me from going to the beach for my vacation. It would have however made me more cautious of my surroundings. Thanks again!

    • sorry about the misprint…the dressing is called “wet to dry” Hope you have a speedy recovery in the New Year…

  21. I went to stingray city and got stung by a very large stingray (3-4ft) on the bottom of my foot. I did apply hot water, but not nearly hot enough. The terrible pain lasted 6 hrs. Then my foot went numb, after a week there is still about a 2 inch area still numb. The Island Doctor gave me Antibiotic pills to take and I am now back from the cruise and feel I need to go see a local doctor, can you give me a recommendation in the Orlando, Florida area?

    • My stingray encounter was back on September 21st and as of today I find that the side of my foot is still purple and it swells with certain shoes on. I was on an antibiotic for a skin disorder for a month and I do think that it helped me. The doctor that I saw on Hatteras also gave me a tetanus shot the day of the attack. I do not know of a physician to recommend in Florida unfortunately. I don’t think it would hurt to have someone look at it. It sounds like your wound is a lot larger than mine. Hope this info helps

      • I have pretty much the same thing happening at about the same point as you, I’m really starting to wonder if it is going to ever be back to 100%. The healing has slowed to the point that it just doesn’t seem to be getting better….(see my story below) :)

    • I would advise a qualified Woundcare Center with an affiliated Podiatrist. Ask your Primary Care Physician if he could make the referral. These Centers are available in many larger cities and provide the best medical expertise in wound management. Best Luck to you!

  22. Well I thought I’d put my story in….10/31/09, out surfing in Solana Beach (San Diego, CA) and could see stingrays fluttering around everywhere. Decided to get out of there and was stepping over the last little wave to go to the beach (about a foot and a half of water) and got hit by one on my right ankle bone. It looked like a hole in my ankle, really only about the size of a grain of rice–but painful. Went to doc, got 5-day antibiotics (Bactrim?), tetanus shot–might not that the doc had never even seen a stingray sting before, but the lifeguards at the beach had all been stung before and there were about 3 others while I was soaking my foot at the lifeguard towere with the same sting. Think maybe after one injury they should probably call everyone in out of the water?!? ANYWAYS….it’s been almost 2 months now and it’s pretty painless in normal walking (even jogging), but hurts like crazy to try to bend my ankle sideways like if you roll your ankle on it’s side basically….not sure if I should go back to the doc for this??? You can still see where it went in and it does look just a tad swollen….STAY AWAY FROM SOLANA BEACH!! Unless you like a ton of wildlife in the water then it’s pretty cool (Solana Beach was the site of a fairly recent (great white?) shark attack on a swimmer about 100 yeards from the beach). I know this is EXTREMELY rare, but I’ve seen all kinds of birds, weird fish, dolphins, etc all cruising around out there! Can’t wait to get back out there in the water when my ankle is healed but I am pretty sketched out at this point….

  23. Hi Ben,
    Sorry to hear about your encounter. Here is is December 23rd for me and mine still looks pretty much the same. I too have to wonder if it will ever be 100%. I guess time will tell. You are much braver then I. I really don’t have any desire to get back into the water anytime soon. Best of luck to you!

  24. Hi all I was stung 5th Jan, its now 13 days later 18th Jan and I have seen 3 doctors and been prescribed 4 different antibiotics. I think I’m on the mend now, the wound on top of my foot is still open and no doctor so far has even looked in detail at my foot. I’m taking Doxycycilne and Cephalexin at the moment and have been on Bactrim and took three tablets of Metrogyl which I didn’t like and which really did nothing. The Bactrim was good but I was taken off these for the Doxy and Cephalexin. I’m amazed how doctors on the coast here don’t know about Stingray injury. I’m on the South Coast of NSW. I’m hoping my injury doesn’t require further medical attention, but I’m not confident that will be the case as it feels a little infected. Will keep you posted. I have contributed information and pictures of my injury to a Facebook site called ‘I’ve been stung by a Stingray” I work as a Community Worker and I intend to make everyone aware of what they need to do when getting treatment, I wish now the wound was cleaned when I first attended the ER on the 5th of Jan

    • If you keep the wound open and allow it to drain freely it will heal faster! It has been a year now for our sting and is almost non-visible at this point on the side of the foot! Yes it is surprising how little docters know about “wound care” when it comes to stingray envenomation! This site has lots of info now and knowledge is wonderful. Especially now you will want to know the steps to take “if” you get stung again!

  25. Hope you’ve helped someone here.

  26. ICON films and Animal Planet released a DVD on the fresh water stingrays of Thailand, some of the biggest venemous stingrays in the world. Some of the information and photos used in the film were taken from this article. Glad to contribute!

  27. Hi,
    I’m chiming in as I’ve recently been stuck by a stingray (two weeks ago) and I think I might have some interesting comparative information. This is the second time in three years that I’ve been hit, and my experience this time is slightly different than last time. I was recently hit in California while going surfing, and I was definitely shuffling. I do not believe that I stepped on the ray, as I felt only the initial jab. I never felt the body of the ray at all, which is different from last time when I kicked or stepped on it while fishing.

    Both times I had scalding water on the wound within 15 minutes, and I kept my foot submersed for almost 3 hours. In my opinion, the water should be as hot as you can stand for as long as it takes. This initial treatment was similar in both cases. Last time I drank about 5 beers and 600 mg ibuprofen over 2.5 hours as a painkiller, starting about an hour after the initial puncture, and it did not seem to reduce the pain. This time I took two hits of marijuana about 1.5 hours after the puncture and it did seem to reduce the pain a little.

    This time I was hit on the fleshy inside of my right foot, as opposed to last time when I was hit on the bony top of my right foot. Both hits seem to have missed arteries and tendons. The previous wound was excruciatingly painful at first, but as the wound healed and the fleshy material died in subsequent days, the skin around the point of entry became incredibly itchy and the swelling subsided. This time the initial wound was not as painful (I don’t think, but maybe I just had a better idea what to expect and for how long, or maybe my painkiller was more effective), but the fleshy area around the point of entry the is still very swollen after two weeks, and the fascia and muscle between the inside of my ankle and my achilles tendon is extremely stiff, sore and painful and runs from the foot up about a one third of the distance of the calf. In particular, I cannot pull back my toes (as in stretch the calf muscle) or turn my ankle outward.

    One thing I noticed about the current injury is that I continued to be able to squeeze puss and some blood from the puncture location for about 8 days after the initial sting, but the puncture is scabbed over now. I have also noticed that the current wound is far less itchy than the first. The affected area, which was black and blue for about a week or more, is no longer discolored, but it is still swollen. I think these last indications may be bad as the necrotic tissue does not seem to be dissipating, and it is still painful and stiff. Last time, as the swelling subsided and the skin became very itchy, the pain also eased.

    I’m not a doctor, but my observation and experience suggest a few things which may be useful in treatment:
    1. Immediate hot water (others say any hot compress) treatment is essential. Don’t worry about it being too hot, as pain is your guide in balancing the discomfort of the hot water vs. the discomfort of the toxin/puncture.
    2. Make sure to promote and even enhance the discharge of blood and puss to the affected area for as long as possible (squeeze the puss and blood out for as many days as you can).
    3. Marijuana did seem to have a beneficial effect as an initial treatment for pain.
    4. Use and apply pressure to the affected area if at all possible for the purpose of breaking down the necrotic tissue. Ultrasound would probably be helpful (haven’t tried it), as is a firm, hard massage followed by movement of any affected muscle tissue.
    5. From what I’ve read and learned, don’t defer to a doctor or medical expert who wants to give you preventive drugs or antibiotics – it is a clear indication they’re unfamiliar with stingray toxins. At the same time, if you are having trouble breathing or with glands, find a doctor immediately.

    Good luck

  28. Al Kline, DPM

    Thanks for those enlightening comments. I particularly like the part where marijuana helped with the pain. Unfortunately, we don’t all have access to marijuana since this is presently an illegal drug in the US. And yes, you are not a doctor and I have to disagree with you on one point: See a doctor immediately regarding ANY stingray envenomation. This is only prudent since a majority of these inflictions can and will become infected. Surgical debridement is almost always indicated.

  29. Hello…. In my search for information on Stingray information, I found this site! I have quite a different story. While In Jacksonville Beach, FL My daughter was hit by a stingray, hers was a puncture in the bottom of her heal… she came down on the barb and it stabbed her in her heal, she immediately let out a horrifying scream, (she is 13 and usually pretty tuff) we got her out of the water her foot immediately turn red and began to swell. we took her to the Local ER (we are living in NC and were down visitinng)they did exrays and cleaned the wound and gave us a prescription for antibiotics and told us her ankle was fractured and follow up at home. Back in NC on Monday 7/19/2010 we were sent for more xrays to be seen by orthopedics to get her ankle casted, then we received a phone call saying her ankle was not broke, but that the stingray barb was in her heal. Needing surgery to be removed, we go to have surgery, to find out that the barb is impailed into her heal bone! The surgeons were only able to remove the barb that was sticking outside the bone. She has an inch and three qtrs of the barb in her Heal bone. her surgery was on 7/20/2010. we remained in the hospital for 2 days on IV antibiotics and then were sent home with oral antibiotics for 10 days. we returned for postop appt.everything seemed to be fine, she was clear to start walking minimally with a walking boot and after 3 days pain and fever have returned. we went back to the doctor/surgeon and have found out that her ankle or grwoth plates are injured and so are the tendons and ligaments surounding her ankle and now is in a cast and awaiting blood test results for internal infection of the bone. I and the doctors have researched and researched all over the world to have found no such reprted case such as this one, I am looking for information on how long the healing process will take, I have found that it varies alot and I am in uncharted territory. My daughter is 13 and the surgeon doesnt want to drill out an inch and 3 qtrs in length and 1/2 in diameter, piece of her heal bone to remove the barb, its an evasive surgery for her and wants that to be last resort. a long healing process and unsure of what will happen. not fun for a 13 year old active girl. I understand that many doctors are unfamiliar with this type of injury, well at least from a stingray. any advice would be helpful.

  30. Linda Scarnato

    I was hit by a stingray on the side my right foot. The pain is like nothing else you will ever experience beleive me I’ve been through labor. The incident happened on July 27, 2010. Today is August 5th and even though the wound has finally healed it is still tender. The best advice I can give about this miserable experience is see an infectious disease doctor as soon as possible. This is not a typical wound and needs a specialist. Trust me I know.

    • Hi Linda,
      I was stung on my foot by a stingray close to four weeks ago but I still don’t have full movement in my toes, nor can I wear shoes that cover that area or place weight on the front of my foot either – that is still very painful. I know I have to go to another doctor, but those that I’ve called in my local area don’t seem to know about ongoing treatment. The area around the puncture is a very hard and becomes swollen after I’ve been on my feet for over an hour or so. I’m a bit nervous, but will try to find some help. Thanks for sharing your story.

      • Hi jasmine
        I was stung 4 weeks ago and have the same symptoms as you. I am not sure what dr to go to next? Have you had any luck?

  31. On 7/30/2010 at 10pm my husband was hit by a stingray while pulling in a shrimp net into his boat it hit him in the inside of the upper thigh of his left leg, it was 7/31/2010 at 10pm when he started having tremors and problems breathing that we took him to the local ER where the doctor in the ER had x-rays taken of his leg to find the a 4 inch barb still in his leg the ER Doctor told us that it had to come out… the next morning the surgeon came in to tell my husband that they were going to leave the barb in his leg. I went home and made several phone calls and research on the internet after having some information I had my husband released from that hospital to get a second opinion after taking him to another Emergency Room at another Hospital they did surgery on 8/1/2010 at 10pm they did surgery as soon as possible to get the barb removed from his muscle in his leg. Thanks to all my friends and the phone calls that I made to have the knowledge to get him out of the first Hospital and get the second opinion, if not I’m afraid of what might have happened to my husbands leg. Now he has about a 6 inch insession in his leg. My advice to you would be don’t be afraid to get a second opinion and do your reseaech talk to friends, family and neighbors. Living within 4 miles of the ocean you would think the local hospital would know what to do! But I was wrong.

    • I,ve heard of many similar stories. Kudos to the surgeons who removed the barb. If possible the barb shoud always be removed, as any foreign body. Thanks for sharing this story and a speedy recovery to your husband.

  32. Dr. Kline,
    The episode of “river monsters” is the “deathray” episode. They bought my photos and sent me the dvd. Almost 1 1/2 years after my sting, I ended up with a nerve disease called CRPS/RSD. I have permanent damage and neverending pain. Walking is painful and difficult due to both the crps and the mechanical damage (loss of tendon). Please keep telling people to make sure the wound is properly treated. The crps was a result of the surgeries that followed the infection. preventable. Thanks, Stacy

  33. Today Saturday, 9/4/2010 while swimming in mid-torso deep water at Ft. Desoto park, St. Pete, Florida I was stung by a sting ray. The penetration mark is on the interior portion of my left heel (actually between my heel and ankle). Initially it felt like a really painful burning pinch, I screamed out getting my husbands attention. I limped to shore with his help, it is a small “hole” and was oozing light red fluid. did not look like blood, like serrous fluid. I was not sure what to do so was squeezing it. It began to hurt like no other pain, I was stupid and stuck it in ice water… it was a long limp back to the car. Then another 40 min to get home. As soon as I got in the door I immersed it with the hottest water I could tolerate and scrubbed it with hibiclens. Then pain became almost intolerable, I thought I was going to pass out. I then soaked it in super hot water for another hour. I took 3 ibuprofen and a percocet (prescribed for shoulder surgery), the pain is gone from the area. However, my calf hurts, I feel lightheaded, woozy off and on. I have been monitoring my vitals my BP is low but not bad. I scrubbed it with iodine swabs, and flused it with sterile water. I do not have insurance.. but wonder if it is infected when should I notice, by tomorrow? I have oral antibiotics but want to avoid if I can. I am surprised at how bad my muscles ache, especially in that leg. Any advice is appreciated… I have read all the posts and all the info – it is so helpful, when little info is out there.

    • I ended up seeing a physician who in turn gave me a tetanus shot. I also took and antibiotic. It has been a year ago that I was stung and at times I still have a bit of swelling and redness. Best of luck to you.

  34. I was stung by a stingray at Honeymoon Island in Dunedin, FL today Wed. Sept. 22. I was shuffling my feet but still got hit on the inside lower portion of my foot. Just a small puncture wound that bled for the first 15 minutes until I made it back to the car where I cleaned the wound with alcohol wipe and placed band aid over it. Drove home about another 15 minute drive. Took two advils for pain and have been soaking in some very hot water for 1.5 hrs. Cleaned wound with rubbing alcohol and noticed 70% of swelling has gone down since I began soaking, and pain pills are working. Will soak and for another 1.5 hrs and massage hard swollen area about the size of a half inch around puncture point between soakings. Dont like doctors, have $2,500. deductable on insurance, don’t have the money. The pain in the first 30 -45 minutes was pretty scarry, is there any over the counter anti-biotic I could get without a doctors visit ?

    • John – sounds like you were swiped and do not have the barb. Just throwing it out there – but maybe your insurance covers walk-in clinics? They can debride,xray, give you an antibiotic and tetnous all in one shot.
      Sounds like you have the pain under control. Neomycin ointment, epsom salt… go to CVS/walgreens get these ASAP. The anti-biotic (triple) ointment will help keep out infection, you need to soak it twice a day. If you can pick up some Hibiclens(blue bottle) they use it in surgery and we (I am a nurse) use it on MRSA patients. The biggest prob you got with your sting is staph infection. Have you had a tetnous booster in the last 2 years? If not, you need to call your primary and go get one tomorrow, perhaps ask for some Bactrim DS orally… TETNOUS is IMPORTANT!!!
      My sting is 3 weeks old and FAR FAR from healing… I soak it, clean it twice a day… do NOT take any aspirin… are you on coumadin?? anything like that and you need to go to the drs tomorrow! mine bleed for over a week!! let me know how you get on.. I feel really bad for you… good luck!! stay off your feet!! keep it elevated.

  35. Hi – I wanted to offer support for everyone that has been barbed by a stingray. I was walking out of the water at St Pete’s in FL and was almost at the beach, when it felt like someone had hit me with a ballpein hammer on the top of my left foot. I have never felt pain like that before, it bled like crazy and my my foot started spazziming all over. It looked like pencil lead was coming out of it. We did not know what had happened and my husband helped me to the car.

    I was in so much pain it was unbelievable. He was mad at me, I was mad at him, I yelled and I cried, which is totally not how I react to things. I did everything wrong! I was flying back to Canada the next day and we thought we would spend a day at the beach together. I had some fudge in the car and when the pain became unbearable I would eat a bit and the pain would ease a little. Proof that chocalate can definaltley heal!

    My husband pushed me to the hotel room in the luggage cart with me not “keeping it together” I think the staff thought he was beating me. I immediately soaked my foot in cold water thinking “at last this will help”. Instead I started feeling sick with headache, nausea and heart palpitations. I was very scared then. We went to the hospital and they immediatley recognized it and xrayed my foot,gave me a tetanus shot and soaked it in very hot water. What a relief, but when the water cooled off my hubby had to fill it right away. I did this for days. It was slow healing and took a full year for all the swelling to leave, I always had extreme pain in my lateral malleuous (outside ankle) and foot pain that came and went. It is 5 years since then and the top of my foot still hurts, it feels very stiff sometimes and at night I have to keep it sideways to keep the pressure off. I’m glad I found this site and info. along with all of you. I just wonder what this will be like in another 5 years. I feel like some of the venom may be trapped in there but realize that it is probably just long term damage.

    Best wishes to everyone in their healing. Special wishes for Angie’s daughter, it’s important to know that she is not alone and we are behind her in her healing.

    Susan

  36. I stung by a stingray in March 2011 and it was the worst pain I ever had. I was at Honeymoon Island, Forida and went to a near by clinic where they put my foot into very hot water. They said from April for at least 5 months they have at least 6 people coming in from sting ray attacks and there is no warnings on the beach. I was lucky that my wound healed. I still will go back to that beach but I will wear swim shoes when going into the water and do the sting ray suffle. Be careful as especially with children it can be very dangerous.

  37. Hi just saw all the comments of the unlucky ones that were attacked by the stingrays. We were in Madeira Beach in April 2011 and tomorrow will be a week since the stingray hit my right foot. It was around 4:30 and we thought we would hit the Ocean for a swim because we were hot and lying in the sun on our beach chairs. We were out to our chests at least and all of a sudden I felt like my foot had been hit with a knife. I said, I thinks something has hit my foot, it hurts and and limped to shore as the pain was pretty bad. I was worried because I thought it might have hit a vein (god help me)!! It was bleeding and the cut looked like it was cut by a blade. I put the towel on it to stop the bleeding thinking it may be a vein. I limped to shore in agony and we had our computer thankfully and googled what to do. We soaked it in a stainless salad bowl with the hottest water I could take with alot of salt. My Mom is a nurse and I am an aesthetician so we know how to take care of skin that is for sure!! She kept boiling water and refilling for an hour. As soon as the water starts to cool the pain comes back but as long as your foot is emersed in the very hot water you feel fine. I took it out and put the neosporin ointment on it and actually went across the street for dinner. We were leaving the next day to come home and I even walked to John’s Pass to buy a few things and of course have a iced mocha latte at my favourite coffee place (Addicted to the Bean). I limped a bit but kept putting the ointment on. The problem with these attacks is the stringray sometimes leaves some of the cartilage from their tail (it is made up mostly of cartilage) and it may be inside the foot still. On Good Friday I went to the Dr.’s after hours clinic and they put me on antibiotics because it was quite swollen and red and yesterday I finally got an X-ray. Tomorrow I will see if anything is wrong and they said maybe I will need an ultrasound on it as well. These attacks cause tissue damage, damage to nerves and ligaments and bone. Take care when going in the Ocean and shuffle your feet. These marine animals sometimes bury themselves in low lying areas under the sand and if you happen to step on them they attack. I will be more careful when going into the Ocean. I am almost 46 and have been going in the Ocean all my life and love it so I guess I was just unlucky. I am glad it was me and not one of my children. I kept thinking of Steve Irwin and I guess it could have been much worse!! Good Luck and hope this helps someone else who has gone through the same experience.

    • Mw again,,,,, just wanted to say I left out how long I had to soak my foot. I soaked it for 1 hour but you can do it for two hours. It also said to seek medical attention and we were going to but we thought we would wait till we got home because it seemed ok.

  38. I just got stung on 5/15/11. My boyfriend immediately peed on it and did several times before I could get back home and get in hot water. He hit me in the R front side of the ankle right between the joint bones. I never went to the hospital. (I wanted to go but he kept telling me not to worry about it) Now I have a dark black coloring showing on my foot going downwards of the puncture site and what looks like possible necrotic tissue. Still have swelling in the ankle and foot. Mild pain every once in a while but when I touch areas on my foot i get nauseated. I was just laid off in January and have no insurance.

    Do you think its too late to go to the ER?

    • Liam O'Sullivan

      Melisa I would get some medical treatment ASAP..in the mean time try salty warm water poured over the wound once or twice a day, allow the water to dry and stay right off the injured limb. You’ll most likely need antibiotics. It took me two months and many doses of antibiotics to get the right medication to heal my wound.

  39. I just saw a girl in my office who read my article on the internet. She happened to live in my hometown and her father brought her to my office. She is 14 yo. She was hit on the back of the left heel while on a school trip at the beach. She submerged her foot in hot water, which helped with the pain. However, she went to the ER the night it happened and was sent home with antibiotics and pain meds. She saw a number of doctors thereafter who suggested ‘waiting’ to see if it would get better. By the time I saw her, it was 2 weeks after the injury and it was very apparent she should have gone in the hospital and to surgery right away. I switched her antibiotics to Ciprofloxacin and Cleocin. I called her primary doctor and she was admitted to the local children’s hospital. They took her to surgery and removed about a 1 inch stingray barb from her heel.

    Photo: Initial Presentation day of injury
    Photo: Post 2 week injury

    Moral of this story: If you get hit by a stingray barb, you need to go to the hospital and undergo surgery to open the puncture site. This helps to both ‘clean’ the site and remove any additional foreign body material. The girl’s father brought the barb to my office for me to see. It was quite impressive.

    Another interesting point to this case: X-rays initially taken at the ER did not reveal any stingray barb. So, I would say, that x-rays are probably very non-specific in determining whether a barb is present or not.

  40. I got stung by a ray in the left foot just below the inside ankle bone last Saturday July 9, 2011, on the beach below Cardiff-by-the-Sea, CA. I was standing in about three feet of water, watching my family boogie board. The lifeguard had just made us move down the beach a bit because of the strong undertow, so I must have disturbed the critter! Initially I thought I got bit by a crab or something, Then the intense pain began! I made it to the beach and my family gathered around me. I was bleeding some, but it didn’t look like blood, it looked like jelly oozing out of my wound! Must have been the venom mixing with the blood. My husband squeezed it to get as much out as possible. A woman who happened to be passing by looked at it and knew that it was a stingray sting. She gave us the best advice possible: soak it in as hot of water as I could stand. We were right below a restaurant, so my son went up and asked them for hot water. They gave him a pitcher like they use to steam milk for lattes, filled with hot water. My husband immediately began pouring it on the wound. Boy did it feel good, even though it was hot hot hot! I was sitting up and felt very light-headed, like I was going to pass out, but as soon as I laid back in the sand, I felt better. I think I was hyper-ventilating a bit, trying to manage the pain! The lifeguards then came and trucked me to the parking lot, and my brother met us there with the car and took me up the hill to his house, where we were staying. The time between my husband stopping the hot water treatments on the beach and my brother’s bathtub was the toughest time of the ordeal! The hot water really does help manage the pain, as well as minimize the effects of the venom. Get your sting in hot water ASAP!! I soaked in the tub for about an hour and a half, and by then the pain was virtually gone. My husband probed the wound, looking for any barb, but it didn’t feel like there was anything in there and he couldn’t see anything. I took some ibuprofen, laid down, and took a nap. When I woke up I could put pressure on the foot, and by Sunday, even though my ankle was quite swollen, I limped back down to the beach and sat in a chair while my family played. The only thing unusual I noticed that day was general muscle fatigue, especially in my back and neck. I tried to wear a small backpack up from the beach, but got very tired carrying it after just a few minutes. This fatigue lasted the rest of the day. We had two days of Disneyland scheduled for Monday and Tuesday, and I made it!! I wore flip flops and went slow at first, but by the end of Tuesday I was cruising pretty good. The wound is about 1/4 inch long with a dime-sized area of red around it today (Thursday), an area of yellowed bruising by it, and my ankle is still slightly swollen, but I have no pain. After reading all the horror stories above, I feel very fortunate to have hopefully had a mild incident with no after effects.

  41. Just an update on my condition: two days after I posted the above story my foot began to swell, the wound got really itchy, and I was in so much pain I couldn’t put pressure on my foot. The wound started to turn black. I also developed a rash above the ankle. Since I had been doing so well and this was such a change, I went to the doctor for x-rays. There was no apparent barb in the wound, but the doc did put me on antibiotics. They are really helping! I think my body just needed a little extra boost to heal. Today (Thursday) I am doing much better. The swelling is down, the wound doesn’t itch and looks like it is healing. Yea!

  42. Oh no! I got barbed last Tuesday 9/14 in Key West. When I got hit OUCH!!!! I put immediate pressure on the wound and the pain subsided. One of my friends poured a cold alcoholic drink on it and we blew it off since the pain subsided, No big deal, right? I walked and did A LOT of water sports over the next 4 days and SHARED my concern with the people running the water venues. They said don’t worry! I called an urgent care center and they said if gets worse I may want to have it checked out!

    Update: 9/22 I walked into an urgent care center. I went back to work on 9/21 and when I got home from work the wound “itched”. Today, 9/22 about 3:00 at work I noticed my shoe was feeling very tight. I wear a very good orthopedic type shoe at work because I am on tiled or wooden floors on my feet for 8 to 10 hours a day.

    After work I went to an urgent care center. I live in NE Florida and the PA at urgent care knew far less about stingray venom than myself. She put me on clyndamycin hcl 300 mg. I will be in my doctors parking lot when their doors open!

    Question: Key West, stingray barb, water sports, local urgent care center…WHY didn’t someone “urge” me to “just get it checked out?”

    Thanks for this information!

  43. i got hit in venice beach ca in july & still have pain in my foot. the strange thing is that ever since the sting i can hear my heartbeat. sounds nuts but the 2-3 hours of intense pain just after the sting my heart was pounding out of my chest. now it ticks in my head like an edgar allen poe story.

  44. So glad I found this site. I was just barbed by a four foot ray in the underside of my arm, just below the wrist. I have been working with the rays in the Cayman Islands for over 12 years. It was just a an accident, not the ray being aggressive. I was in waist deep water and a wave just sort of pushed the ray into me. The problem was, I couldn’t get the stingray off my arm. I had to tug very hard about three or four times before my arm finally came free, which resulted in a two inch gash in my arm. The pain was instant and almost unbearable! I had to try very hard not to pass out as I drove the boat back to the dock, 30 minutes away. I immediately went to the hospital, as I was aware of the possibility of infection and skin necrosis if left untreated, plus I knew I would need stitches. The wound was scrubbed, irrigated, and eventually stitched up with a drainage tube inserted. I was also taken for an x-ray and ultrasound to make sure there was no foreign material left in the wound. I received a few different IV antibiotic drips, as well as some pain medication while in the hospital, however I must say that whatever pain management they applied had little or no effect. I have never experienced such excruciating pain, and it unfortunately lasted about 7 hours. It’s been about two days now since the laceration and I am at home with a few bottles of oral antibiotics, as well as some pills for pain and swelling. Currently my hand and arm are fairly swollen – I was told I look like Professor Clump. Going back in for an evaluation tomorrow, so I hope it is healing properly with no infection.

    • I am so sorry to hear about your accident. Getting barbed can be so tramatic in many ways. Have you been using hot water therapy? That was the only thing that controlled my pain when I was barbed and seemed to stop the spasms in my foot. It totally neutralizes the venom but you must keep it up with water as hot as you can stand it.

      Taking care of yourself right now will really assist in the healing process. I wish I was more procative right away as it was almost 2 years before my foot went back to normal size, but then I did everything you were not supposed to .

      Best wishes for a speedy recovery, I’m so glad that you do not blame the ray. I felt the same way and actually feel a bit of kinship with the species. They really are not out looking for trouble, I just stepped on him.

      Sue

      • Thanks Sue,

        We tried to apply a hot-pack immediately after the incident, unfortunately it was accidentally activated in the first aid kit some time prior. The pain is thankfully gone, now my arm is just a bit sore and swollen from my wrist to just above the elbow.

        I hope your foot is back to normal now. Yes, the ray certainly wasn’t trying to cause me harm – she, like me, was just in a bad position at the time of the incident.

        All the best – Gord

  45. the hot water was the only thing that could touch the pain !

    Got stung, last week on the coast in El Salvador.

    Had no clue what hit me at first, just felt something there and then intense pain. Within an hour I felt the pain/burning/throbbing in my right hip. Went back to the resort and the doc gave me a few injections of antibiotics and anti inflammatory.

    He cleaned out the wound and flushed it with lidocane (I think), that actually felt really good. When i got back to my room i looked online and found out about the hot water. By that time I was in agony, soaked in hot water for 90 mins then no pain.

    My foot ballooned overnight, my ankle completely disappeared due to swelling, and the throbbing came back. The doc put me on cipro. The only plus in this experience was better seats on the plane ride home and bypassing the lineup in customs at pearson airport !

    The puncture is a bit itchy now, and still numb to the touch and swollen slightly but I think the worst is over

    I wish the locals knew about the hot water treatment, instead of telling me that my heart was going to stop and that I was going to die.

    • I read over this entire site again just to be ready if need be so it will be a reflex action of treatment if stung! Snorkeling presently in Roatan and give distance to “stingrays”. Me and Cathy have encountered Rays numerous times since her envenomation. Then there was almost nothing for info on this. I have steered many people to this site over the years to familiarize themselves in case they are stung! The ordeals are always long. The sting almost always underestimated but why would it not be? It is just a sting! This site has been used at our local hospital for reference!

  46. I was stung last summer in Florida mid calf. Not only did it puncture the skin but ripped a chunk out as well leaving a small part of the barb. Almost a year later I still have twitching and pain in my calf muscle! Not to mention a nice sized scare.

  47. My daughter was stung today by a stingray at 1:00 on the big toe. We were able to get treatment at the local ER within 90 minutes. After reading all of these posts I am worried they may not have done enough at the ER. They soaked her foot in hot water and rinsed it with betadine and gave us 2 weeks of codeine pills and cephalosporin. They x rayed it and said they didn’t see any stingers. They told me to change the bandage twice a day and keep it elevated. I was wondering if I need to do anything else? Should I soak it again or would this be worse? They did not debride it? Should I be concerned? I just feel like I should be doing something. Any ideas? Thanks for any advise.

    • Hi how is ur daughters foot? Did it heal ok? Any issues since? Does she feel a warm sensation around the area or foot? Curious to know as its been 4 wks since I was stung by a stingray and still have mild swelling. Would like to hear from u. Thnx. Anita

      • cliff.prystie@gmail.com

        You sound like your foot is doing well! But is there any dark residual left in the area? If there is it may have to be debrided due to secondary infection!
        Sent from my BlackBerry® smartphone

  48. aug 17 2012 sandeigo ca … thought at first it was jelly ( guessing ) next thought was a crab … life guard was in his truck watching me… he immediatly knew it was sting ray .. lots of blood. he applied a turnaket compress.. then soakd emediately hot hot water over and over for abot 2 hours… extremly painful ..hard to discribe..i had been enjoying some drinks so i was bleeding alot …left foot just under the toe… its the second day and im AFRAID to go see anyone who claims to be a doctor,or medical advisor in this very small town in the high desert .. my inquiry is has anyone tryed to find out what our native americans did for this..? With Herbal medicine. tincures, compresses ,exc. Anything I Can do to STOP STAPH AND FLESH EATING INFECTION !!!! IN MY BLOOD !!! I have read all this CRAZY SCARY stories and IM FREEKING OUT …. i would Highly appreciate any info u can provide to cure myself … i am familiar with some native medical plants but not enouf … im a 36 year old female and have no where else to turn… thank you … Stacie D.

  49. Was coming out of the water on Turtle Beach FL…felt a sharp pain and suspected it was a sting ray as I had seen at least 2 baby stingrays a day over a 2 week period on my daily walks on the beach. Once out of the water the inside of my left foot below my ankle was bleeding profusely. People @ the beach called 911. Sat on the beach and pressed the towel over the very tiny puncture and the bleeding stopped. EMT was there shortly thereafter…asked if i had shortness of breath or nausea or palpitaions and oddly enough the only advice from them was to put it in hot water as hot as u can stand….asked me if I’d like to go to the hospital…sort of an after thought and when I declined I was asked to sign. Being on Siesta Key u would think they would tell me I really ought to go to ER. I took their advice and sumberged my ankle in hot water for about 30 mts the pain subsided as long as it was in scalding water. Later that day I flew to NJ and the pain was all but gone. Mild swelling and a little bruising, scab over the very tiny puncture…no worries. NOT SO!!!!!! 10 days later after a run started to feel my shoe a little tight..wake up the next morning foot has blown up no sign of my ankle….go to Urgent Care, Dr gives RX for Levofloxacin, take it that day wake up ankle is bigger…call Dr he advices go to ER ASAP. Walked to ER..few hrs later I need crutches to go to th bath room afew feets away. Xray and MRI show no barb…incesion made on opposite side of wound and sample sent to lab which showed increased white blood cells and not much else….admitted and put on IV antibiotics and scheduled for surgurey late the next day. Dr decided not to operate but do a bed side procedure which essentialy was picking at my tiny puncture scab…again taking samples to lab. No results. Discharged on day 3 after being on IV antibiotic for 48 hrs…Rx for oral antibiotic Cefadroxil 500mg 2x daily…and clean the 2 incesion made by them with bacitracin. Home for 48 hrs no relief…dont want to go back to ER but after reading all the posts I think I should. If anyone has any advice please let me know. Thanks

    • get on clindamycin and ciproflaxin ( 1500-2000mg each per day).

      that should clear it up quickly.

      My foot didn’t get back to normal for 2 months, you just don’t want a staph infection or worse (vibrio, which you really really don’t want)

  50. Stingray wound found with a plant pathogen: Lasiodiphlodia theobromae
    (I never sighted the stinging critter, but have been informed the site is classic for a ray injury)

    If still of be interest, I was recently diagnosed with an infection from the above plant pathogen. I made access to details available in 3 sources.

    1) http://www.youtube.com/watch?v=dFnwnNnZaY0&feature=share&list=UU1X-SlzJ6vFIZV9SCm-3sCA
    2) https://www.facebook.com/notes/christopher-trench/stingray-contact/10150972813316434
    3) http://www.sunshinecoastdaily.com.au/story/2012/08/15/sting-in-holiday-tale-coast-man-thought-he-would-d/

    The condition has been difficult to identify and treat. I’ve been using Vfend® 200mg 2x daily since 28AUG12 and clinical progress is evident. The Grade 111 ulcer has since closed, but the foot remains somewhat swollen and the ankle feels like it’s been sprained. I have more or less exhausted the information I have on this subject, which is available in my open Facebook “notes”, the link of which is given above.

    In a sense this is a case report, except I’m the patient.

    • cliff.prystie@gmail.com

      A secondary infection from the initial envenomation? May have to be debrided? Check thoroughly with physician also check too see if cartilidge present! Goodluck!
      Sent from my BlackBerry® smartphone

  51. Hello,
    May 1, 2006 my husband and I were fishing in the mosquito Lagoon near Titusville Fl. Beside the space coast. There I was stung by a sting ray in the inside if my left ankle. From the ankle bone to the Achilles’ tendon. There was no bleeding for a few hrs. The wound just swelled shut. I did not receive any medical station for 3 days because after taking a bath. Most of the pain went away. After going to Bert Fish Hospital in New Smyrnia fl. There I was tested for infection of the wound and a X-ray. And was sent home with a prescription of cipro for 10 days.
    During that time the outside if the wound was closing. 3 weeks later on may 21 I went back to the hospital because the area around the wound started swelling and was every shade of red and purple. At that time they reopened the wound and they found out that because the wound was never cleaned out the first time I went in. There was black slime still in there and dead tissue. There was a repeat of wound culture, blood work with blood cultures. I was then started in 2 unites of antibiotics and a prescription of amoxicillin. And schedule for the next day to see fl. Shark and sting ray specialist.
    The specialist started by trying to numb the wound and area so he could then debriding. I had no pain until he got to the nerves that were damaged. He explained that he cut the ends off because of all of the infection and and toxins from the stingray that what was damaged had died. That it would help them heel. The would was then packed and sent home and I back or the next
    4 days for cleaning and repackaging.
    I was told that the infection that I had was level 4 strep in the wound and in the blood.
    Over the next several months it continued to heel. By September there was no more scab.
    But having trouble walking. Lots of plain even after short walks. Even to this day I still have trouble with pain from the injury. I was tested for nerve damage. And was told that it is just the smaller nerves that are damaged and there is not much that can be done for this. I have receive some Physical therapy for that ankle. Along with An ankle brace. My biggest thin today is that I can no longer run. Because that ankle will not push off to run. Only a lite jog.
    Another symptoms that I have are example when I get in he shower it feels like I have a band aid on the arch of my foot. Or when I work long shifts on my feet the ankle to the arch of my foot I get stinging (like little bee stings) from the ankle bone to my heal and arch of that foot.
    I am not being treated for any of this at this time. I have just leaded to adjust and live with what it is. But I would like to know if there is anything that can be done to make this any better.

    I do have pictures that I may be able to send you from the time this happened, through the heeling until now. It still turns red and swells very bad.

  52. Hello,
    May 1, 2006 my husband and I were fishing in the mosquito Lagoon near Titusville Fl. Beside the space coast. There I was stung by a sting ray in the inside if my left ankle. From the ankle bone to the Achilles’ tendon. There was no bleeding for a few hrs. The wound just swelled shut. I did not receive any medical station for 3 days because after taking a bath. Most of the pain went away. After going to Bert Fish Hospital in New Smyrnia fl. There I was tested for infection of the wound and a X-ray. And was sent home with a prescription of cipro for 10 days.
    During that time the outside if the wound was closing. 3 weeks later on may 21 I went back to the hospital because the area around the wound started swelling and was every shade of red and purple. At that time they reopened the wound and they found out that because the wound was never cleaned out the first time I went in. There was black slime still in there and dead tissue. There was a repeat of wound culture, blood work with blood cultures. I was then started in 2 unites of antibiotics and a prescription of amoxicillin. And schedule for the next day to see fl. Shark and sting ray specialist.
    The specialist started by trying to numb the wound and area so he could then debreeding. I had no pain until he got to the nerves that were damaged. He explained that he cut the ends off because of all of the infection and and toxins from the stingray that what was damaged had died. That it would help them heel. The would was then packed and sent home and I back or the next
    4 days for cleaning and repackaging.
    I was told that the infection that I had was level 4 strep in the wound and in the blood.
    Over the next several months it continued to heel. By September there was no more scab.
    But having trouble walking. Lots of plain even after short walks. Even to this day I still have trouble with pain from the injury. I was tested for nerve damage. And was told that it is just the smaller nerves that are damaged and there is not much that can be done for this. I have receive some Physical therapy for that ankle. Along with An ankle brace. My biggest thin today is that I can no longer run. Because that ankle will not push off to run. Only a lite jog.
    Another symptoms that I have are example when I get in he shower it feels like I have a band aid on the arch of my foot. Or when I work long shifts on my feet the ankle to the arch of my foot I get stinging (like little bee stings) from the ankle bone to my heal and arch of that foot.
    I am not being treated for any of this at this time. I have just leaded to adjust and live with what it is. But I would like to know if there is anything that can be done to make this any better.

    I do have pictures that I may be able to send you from the time this happened, through the heeling until now. It still turns red and swells very bad.

    • Hi Tracy

      I am so sorry to hear about your stingray incident and complications since. I have had ankle pain after being hit in 2005. It continued on and off for about 5 years and now only seldom bothers be. I used massage and some essential oils on the actual malleolus (ankle bone) and it helped. I was hit on the top of my foot but it travelled to my ankle instantly with that stinging vibrating kind of pain. I did everything wrong when it happened as I did not know what to do. This kept the venom alive andl doing damage till I went to the hospital.

      Please know that this can happen and you are not alone. Getting barbed by a stingray is very traumatic and it does have some lasting effects, physically and emotionally.

      Warm wishes,

      Sue

  53. I was stung on April 6th. Went to the emergency room in St. Petersburg. Received treatment & was put on antibiotics. I missed two doses & when I got back home to Michigan it got infected. I was put on 2 antibiotics – Cipro & Doxycycl. I am doing better, but still have some swelling, it’s very tender & the small circle around the cut is hard. I’m trying to find out if this is normal. I’m not on any more meds. Not really doing anything other than keeping a bandaid on it. I haven’t found much online on the long term treatment of this. Can you direct me somewhere?

    • Check with a woundcare professional at you hospital? They may want to debride it to help it heal properly! This worked for my better half also who happens to be a nurse!

      • Thank you SO much for the advice. I have an appointment Monday at a wound care clinic. I didn’t even know such a place existed.

      • Just wondering how long it took your wife to heal after the procedure. I have an appt with a surgeon next Tuesday. So tired of this thing. Its been 2 months now. 2 weeks ago I tore my calf muscle during exercise class because I’d been walking on the side of my foot. I love to walk & be outside & I’m stuck inside with my foot elevated. :-(

  54. We were in St. Petersburg, Fl and I was “stung” on April 6th, 2013 on the inside of my ankle. Worst pain I ever felt. Went to the ER. They soaked it in hot water, gave me a tetnus shot and two prescriptions. Came back to Michigan and it got infected. Went to walk-in clinic. Had Xrays done, got a shot and another prescription. It’s been a month and I still have some swelling. the wound is finally scabbed over, but it’s still very tender and the small red circle around the wound is very hard. After reading everyone’s stories, I feel lucky it wasn’t worse and I’m guessing I just have to be patient and wait for it to heal. I can’t find much information on long term treatment. I am just keeping a bandaid on it. No more antibiotics. Elevating as I can. Tried to go back to exercise, but it throbbed for two days after. Hoping I can get back to it soon. I hope everyone who had major issues on here are doing much better now!

  55. One more point I forgot to mention. I wish they had not made it seem like no big deal at the ER. And had stressed the risk of infection. I would have been a bit more careful. And would not have checked my carry-on at the airport in Tampa, which contained my antibiotics in it, thinking I didn’t need another dose until we got home. When we got home, our bags did not make it. I did not get them until the next night after my ankle/leg swelled up.

  56. Hello,
    I am writing this from the hospital. Wednesday June 26, 2013 my husband and I were swimming in the ocean at Clearwater Beach, Florida when my hubby was stung. He ran out of the water bleeding from the top of his left foot. He was in horrendous pain and could barely talk. I immediately ran to the nearest lifeguard to get help. She seemed like an unimpressed teenager working on her tan. I ran back to my husband and the lifeguard slowly strolled over. She looked at his very small slit of a wound and gave him a hot pack saying he needed to soak it in the hottest water you can stand. We went up to our hotel room (all this happened in front of the hotel) and he soaked it in the tub with hot water. Immediately after the soak a good size blister appeared. We went back out to the ocean an hour and a half later as he said it wasn’t painful anymore. Friday (2 days later and still vacationing in clearwater) he woke up with his foot very swollen, discolored and unable to bear weight. We got in the rent a car and went to the closest urgent care (Bayside) they xrayed it to make sure the barb wasn’t still in there- which it wasn’t. Since he’s allergic to penicillin they had to prescribe an oral antibiotic vs intermuscular injection. We picked up his Cipro 500mg twice a day along with a medrol dose pack (steroid). He stayed off it that whole day and we were able to fly home to North Carolina the next day. It was still slightly swollen but he said significantly better. Very early Monday morning (5 days after the sting) he had a 102.7 fever, chills and body aches. His stung foot was even more swollen. I took him to the ER here in Charlotte where they immediately admitted him for intravenous antibiotics. Believe it or not after 24 hours of IV antibiotics at the hospital it all got worse! Skin looked like it was going to explode, it was red, purple and black, started forming lots of pus bubbles and it was oozing clots of blood. Tuesday (1 day after being admitted to the hospital and 6 days after the sting) the orthopedic surgeon said we had to do surgery to prevent sepsis (infection in blood stream) and stop the tissue necrosing(tissue death). They took him to the OR 45 minutes later opened his foot and cleaned it out, apparently the bleeding and drainage wouldn’t stop so they had to put in a wound vac (drainage system that has suction)! Tomorrow is Friday (5 days in hospital and 9 days since the sting) they will let him go home as long as his blood work is good, but it doesn’t stop there. He has to take the wound vac home for an undetermined amount of time and have a PICC line put in so they can continue IV antibiotics (vancomycin) on an out patient basis. He is a mechanic so the surgeon said he would be out of work at least a month!!! The surgery cultures came back positive for the bacteria staphylococcus. Such a freak thing, but after reading all these posts I don’t understand why lifeguards, EMTs, and other professionals don’t take being barbed by a stingray more seriously??

  57. It’s been several years since I wrote this article and it doesn’t cease to amaze how under treated this injury is. I would recommended that all sting ray envenomations go directly to the OR whether there is a barb or not remaining in the foot and be treated as an open I&D.

    • Stacy Williams

      Me too! If mine had been treated right, according to another doctor, I wouldn’t have ended up with CRPS. Now I have this incurable chronic pain disease. My life is so different from how it was. I can’t run with my grandchildren or stand very long, and I’ll admit I spend a substancial amount of time grumpy and depressed. So tired of hurting. And all the meds! I’m only 44 and it feels like all the good times are over. People, be proactive!

  58. steve akerman oct 6 2013.

    im retired now and have lived in gulf breeze fl for 1 1/2 years. I been fishing the gulf for forty years and shark fish a lot since i” been here. i fish almost everyday of some type. day starts out normal i run my bait traps and get bait fish and load my shark rods in the boat and drive to my favorite shark place. i’m fishing only with my dog and we go about 12 miles out in the gulf to fish. catch a couple shark, before hooking the ray. after about 20 minute fight i get the ray to the boat, start to cut the line to release, but had a large weight and steel leader 2 ft long that i would have to leave in his mouth. told the ray today was his lucky day and decided to pull in the boat which i did and laid him on his back so he could not strike. bent over to get the side cutters to cut the leader when some how i got hit. the barb went in about 1 1/2 below my little toe and was horizontal at 45 degrees hitting my big toe bone in the middle of my foot. took a few seconds to realize what had happened to me. first tried to pull my foot off of the barb, which i couldn’t do.
    The next thing was to drag the 85 lb ray on my foot, to the back of the boat
    to try and get a saw to cut the barb off. I had the wort pain in my life at this point, could cut him loose. Got a pair of large side cutters and finally got the barb cut. The barb had cut an artery and blood was going every place.
    I called 911 and requested an ambulance to meet me at the dock. I start in hoping not to pass out from the boat 12 miles out, arrive at the dock and no one is there. I call again and after 45 minutes the ambulance arrives from 3 mile away. Go the emergency room in tremendous pain, finally given some hot water that helped a little, waited an 1 1/2 before seeing the doctor and finally getting pain shot. Ex ray the wound and saw the barb was 6 ” in bedded in my foot, decided to transfer me to the mayo clinic in Pensacola.
    went to surgery at midnight. awoke the next morning doc came in and said it would be a battle not to loose my leg, being there was so much damage.
    doc inserted a picc line to deliver the med and 8 days later, said he could not be more surprised but the wound look good and let me go home. It continually is in proving each day. the wound is still open and draining but looks so much better than when it happened. My hope is to WARN also people that fish to the dangers the ray presents.
    i never in my wildest dreams dreamed a ray sting could be so dangerous. hopes this helps some one from going through what im going through.

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