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crushing foot injury

by rhonda
(nj)

My husband works for railroad had a crush injury to foot four weeks ago.he had mri. Ct scan and xrays. No breaks. Just showing soft tissue adema. Problem is he still can not walk or put pressure on foot. Wears a soft cast and crutches. Ices it at night elevates it all day and night but every time he does stand even if only for a few minutes his entire foot turns purple blue almost black. With alot of numbness. Has seen podiatrist. And orthopedic wondering if this could be vascular. Ive never seen a foot turn almost black just from standing. Any suggestions appreciated.


RESPONSE

Hi Rhonda,

You are correct, a foot should never turn black, or perhaps dark purple. The fact that this occurs when he puts his foot down on the ground suggests there is a problem with the blood returning back to the heart. It is somehow being restricted.
If the injury had just occurred a few days ago, my first thought would be that the cast is too tight. Even a soft cast can be applied too tight. However, this is four weeks down the road and one would assume that the majority of the swelling should have subsided by now.
The numbness as well is a sign to me that there is too much pressure somewhere that is putting pressure on the nerves thus creating numbness (as well as the foot turning dark).
The final issue is that it is four weeks post injury and apparently your husband is still in a lot of pain.
Sometimes, initially after an injury there is so much soft tissue swelling that it becomes difficult to spot a fracture or perhaps a tear in a muscle or ligament.
Assuming the doctor(s) treating your husband are experienced, they should be able to guage if your husbands progress is normal or not. This would be influenced on his age, medical condition, weight and compliance with staying off his injured foot.
Assuming all things being equal, I would think that at four weeks post injury, although he may not be ready to do cart wheels, he should have noticed progressive improvement. If this is not the case, then the foot needs to be re-examined including perhaps another MRI.
You would also be wise to show the doctor the color of his foot when in a dependent position. The first thing I would do, if he was my patient, would be to remove the soft cast and see if the same discoloration still occurs, as well as the numbness.
If it does, then I would recommend a consultation with a vascular specialist to assess the patency of his circulation.
There is a condition known as Complex Regional Pain Syndrome (CRPS, which you can read about on my site) that may have to be ruled out as well. The best people to make that diagnosis are neurologists and pain management specialists, usually anesthesiologists who specialize in pain management.
So I would recommend letting his doctor see his present situation and go from there.

Marc Mitnick DPM
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