severe foot pain from trauma

by sean
(greenwich, ohio, usa)

I attempted to kick a ball with my right foot. I instead made full contact with a large tree root impacting my big toe and the toe next to it. Immediately lost mobility, use, and ability to stand on my right foot. I broke my ankle in the marine corps and the pain then is no where near the pain now. It is purple, discolored,and it is getting worse by the hour. According to the emergency room hospital, they claim there is no break in any bones. This I do not believe, however, if it truly has no broken bones, what could be causing me to not be able to have any weight on my foot. It feels as if it has no strength but the pain is unbearable. I have broken several bones in my life and the feeling is so much worse than I remember. Please give your opinion sir or ma'am. Thank you, semper fi.

RESPONSE

Hi Sean,

The first point that needs to be made is that sometimes small fractures will not show up initially on x-ray. Usually around ten days after the trauma, the fracture will show up and be visible on x-ray.

If you are convinced that you may have fractured your toe, you could have a bone scan done which would identify a fracture much sooner, however, I would suggest to you the following:

After making sure there is no dislocation of either the big toe or the toe next to it, then the treatment for what is known as a non-displaced fracture would be the same as a bad bruise, which is immobilization.

Typically, we treat simple fractures of the toes with nothing more than taping and a surgical shoe to prevent motion in the affected toe. You prevent toe motion, you reduce pain and allow for healing. We do not put casts on feet for broken toes as there is no real way to "cast" a toe.

So, my point is treat the toes as if they may be broken by wearing a surgical shoe and perhaps taping the two toes together to add more stability. Since the initial x-ray showed you had no major fracture of the painful toes, then worst case scenario is that you have a small fracture and the above treatment is the way a small fracture would be treated.

Now, short of purchasing a surgical shoe which by the way is very inexpensive, if you happen to own a very rigid shoe such as a work boot, a shoe that does not allow much bending, that too might suffice in preventing the toes from moving up and down when you walk.

Along with immobilization (you can buy a surgical shoe in any surgical supply store), you may also require pain medication if the foot is very painful. That you would need to speak to your doctor.

In addition to immobilization and pain medication, the other consideration in treating the trauma to your foot, would be rest. In order for the toes to not hurt as much, you need to limit your walking. If you have a job that requires a lot of walking or standing, that is only going to exacerbate the pain and may extend the amount of time it takes for the problem to resolve itself.

In summary, my point is even if there may be a small fracture (I assume whoever read your x-ray would notice a large fracture in your toe) and you are being told there is no fracture, then just treat the problem as if there is a fracture by employing the advice I just discussed. If for some reason the pain does not begin to diminish substantially over the course of ten to fourteen days, that might suggest a second x-ray or even an MRI to evaluate possible soft tissue damage.
Marc Mitnick DPM
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