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trauma to bottom of foot

by kimberly
(fort worth tx)

I stepped on a hot wheel car two years ago. I have pain in bottom of my foot in the middle all the way up my ankle still. My podiatrist gave me a boot to wear. The boot feels worse than my foot ever did. It feels like I am walking on a metal bar under my foot now and feels like there is a tight squeeze on my foot when I am wearing and not wearing the boot. He said he wanted to see if he could heel a pulled muscle by getting the inflammation down but it feels worse.


RESPONSE

Hi Kimberly,

Not so sure I agree with your podiatrist's diagnosis.

Two years ago you suffered essentially blunt force trauma when you stepped on the toy car. What I assume happened is that some of the sharp edges of the car pressed into your foot and did damage.
You do not mention if you broke the skin or not at the time of injury. I would also be curious to know if the painful area is presently red and swollen to any degree.

So, now you are two years down the road and are apparently still having significant pain.
If I had to guess and of course that is all I can do without the luxury of examining you, I would suspect you might have suffered a small tear in your plantar fascial ligament which is the large ligament that extends from your heel to the ball of the foot. Essentially, it is the large ligament that is just underneath the skin.

All the muscles and tendons on the bottom of the foot are deeper then the plantar fascial ligament, so if you stepped directly on the toy car, then the chances of you having done any damage to a muscle is pretty low.

As I state many times of this site, trauma to a foot can take longer to heal then trauma elsewhere simply because every time you walk on your foot you are essentially re-injuring an already injured area. Two years, however, is way too long for this to be going on.
You do not mention if you have had x-rays or any imaging studies such as an MRI or even an ultrasound, but I will assume you have not if you are only seeing the podiatrist for the first time.

Here are your options as I see them:

1. With severe pain after two years, I think you need a definitive diagnosis. I would suggest asking your doctor to order an MRI or if insurance is an issue, at least an ultrasound to see what type of damage is causing the pain that you are experiencing. Having an accurate diagnosis makes treatment so much easier.

2. If having an MRI or other studies is going to cause a financial burden and since you cannot tolerate the boot, the idea of taking pressure off the bottom of the foot in order to heal "whatever" is going on is not a bad idea.

What you could consider instead is to go non-weightbearing with the use of crutches, for a period of time. I do not know if your daily schedule would allow it, but it is certainly an option. I would estimate for four to six weeks.

3. Along with going non-weightbearing, you might also consider physical therapy in an effort to move things along.

After two years your condition could be considered chronic and as such is probably not going to go away on its own. Trauma, even trauma of stepping on a toy car, always causes variables that cannot be accounted for just by physical examination. I think more thorough studies are needed in order to remedy your problem.

Marc Mitnick DPM
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