dropped a heavy object on foot

by Tanya
(Ontario Canada)

Twelve days ago when loading a heavy box (approx 25lbs) in the trunk of my car, the box slipped and fell on my left foot! I immediately followed the 'RICE' rules and stayed off it as much as I could. However with the pain remaining intense I went to the ER to have it x-rayed. The doctor reassured me that it wasn't broken however he said I had a 'crush injury'. He suggested an air cast for a week (he also suggested ibuprophen for pain, however I am allergic to ASA).

So my question, here I am a almost two weeks after the injury and my foot although better I am still experiencing significant pain. I can bear weight on it better, but I am now noticing it being cold and have difficulty keeping it warm, and when I walk without the cast (as directed by the dr, to go without the cast in the evening to exercise it) my foot now 'snaps'! I not only feel it, everyone hears it!
I realize that there is no definitive healing time, however I am concerned with the coldness and unsure of what 'crush injury' really means, and should I have it assessed again?
There was initial bruising with minimal swelling, both have improved.

RESPONSE

Hi Tanya,

You know it is impossible for me to be able to tell you when your foot is going to stop hurting as every one heals at a different rate and is dependent on so many factors, probably the most important one being the severity of the initial trauma.

The biggest problem is that initial x-rays do not always tell the full story and if a patient does not improve in an expected manner, the first thing to do is take another x-ray usually ten to fourteen days after the initial x-ray. For instance in many cases a small fracture might not show up initially but two weeks down the road it might be visible on a second x-ray.

Another point worth making is that even with fractures the body part, in this case the foot, may actually feel a little bit better simply because some of the initial inflammation from the trauma begins to subside.

We also have to gauge your improvement based on the fact that you are not taking any pain or anti-inflammatory medication.

I do not know what your doctor's definition of crush injury entails but in its simplest form it just means you dropped a 25 pound box on your foot and it crushed the foot. In a more complex definition most crush injuries imply a broken bone, although I realize he said there was no break.

I am not so sure why he suggested you go without the air cast in an effort to exercise the foot. The purpose of the cast is to immobilize the injured foot, to not stress the joints, ligaments and tendons and give these structures time to heal. In most cases you might do this for a minimum of three weeks before attempting to bear weight and start getting "everything" to move again.

The snapping you are experiencing in most cases signifies a tendon slipping over a bone prominence when you walk; since the tendon is under a lot of tension, it "snaps" over the bone. Since that did not occur before your injury, it certainly does not signify any thing good.

Possibly the part of your narrative that concerns me the most is the fact that you state the foot is cold. This could signify either nerve damage or even blood vessel damage to your foot. I am curious as to whether or not the affected foot is a different color than your good foot; either more red in comparison or more pale. This symptom is potentially the most troubling part of this whole scenario to me, at least.

Most people know their own body and have a "feel" for how long it takes for painful areas to get better and if you were not experiencing the "cold" foot I might be inclined to just suggest continuing to wear the air cast and give it more time, but the fact that the foot is cold is not a good sign at all.

Thus, my advice to you would be to see an orthopedist or podiatrist in your area very quickly and have your cold sensation reassessed as that is the part of your narrative that bothers me the most.

Marc Mitnick DPM
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