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The response to the question below was authored by Marc Mitnick DPM

cellulitis or fracture

by mike
(boston)

hi, the top of my foot, at the base of my toes,started becoming painful about six days ago. it kept getting more painful. i've been on keflex for three days after having been diagnosed at the ER with cellulitis. there was some redness running up my foot and my left foot was much redder than my right. the redness seems to have decreased, but the pain persists. i saw my PCP today and he suggested i check it out with a podiatrist. i was x-rayed at the hospital and no fracture was found. my understanding is that stress fractures are not always seen on standard x-rays. the pain is centered on the top of my foot at the base of the toe next to the big toe. if it is cellulitis should the pain have subsided with the keflex by now? i am still hobbled and in pain, especially when walking or flexing my toes. my foot has been mostly elevated for three days. i've also been taking three advils three or four times a day. thanks, mike


Hi Mike,

Most local
cellulitis that I have ever seen in the area you describe is a secondary result of athletes foot from in between the toes. In other words there has to be an origin for cellulitis secondary to a bacterial infection. Do you fit into that category? If you do, and you have a true infection than the foot after three days should be feeling somewhat better (but usually not completely better); the problem is, simple cellulitis is usually not all that painful.
So, my next thought would be a
stress fracture . You are right, they may not show up on initial x-ray, so they should be repeated in about ten days. If the second x-ray is negative and you are still having a lot of pain, an MRI might be indicated.
Lastly, redness on the top of the foot may be indicative of a superficial phlebitis. Make sure your doctor rules that out as well.
Good luck.
Marc Mitnick DPM

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