needle broke off in foot

by Jackie
(Belleville, Mi 48111)

My Husband stepped on a sewing needle and only half of it came out, we tried to see if we could see it but we can't.. can this get into the blood stream and kill U?

Hi Jackie,
Probably not, but more likely is that the area of the foot will get infected, not to mention painful to walk on.
Your husband needs to see a podiatrist. The longer he waits and the more walking he does, the harder it will be to remove.
Marc Mitnick DPM

Fractured foot bone

by Lara Boltman
(Pretoria, South Africa)

Hi,

On 21 May 2009 I fractured the foot bone just above my small toe in a netball game. Its therefore on the ouside of my foot, left foot. I went to the Dr the day after and got xrays. The xrays revealed a obvious fracture almost right through to the other side of the bone. The fracture was quite far open but a clean nice split. I got a moontboot to wear and this I wore for 7 weeks. I did however walk on my foot with the cast after about 2 weeks. I went back for xrays after 2 weeks on the Dr's request and she then said it looks like it's closing as it's making 'bridges'. Its been about 2 month and 2 weeks since. I would just like to get another opinion or extra advise. At this stage I havn't tried running fast and hard but I can run slowly with my foot without pain. If I jump on the spot there is no pain just sensitivity. And on top of my foot on the left side I still feel discomfort like its a bruise. Is all this normal signs of healing, can it take this long? Are there additional exercises I can do to strenghten in that area or any cream/ointment that will speed up the proses. I do not have the funds to go for another xray soon. I'm only planning to start heavy exercise in Feb 2010 when the new season starts. Thank you, Lara

Hi Lara,
Under normal circumstances a clean fracture without too much space between the bones in a healthy individual can take 6-8 weeks to heal. Immobilization through the use of the boot is the standard treatment.
There are no exercises or creams to apply that will move things along. Smoking with slow down fracture healing.
"Bridging" is the formation of new bone bringing both ends of the bones together to thus close the fracture site.
As I said a moment ago, if you are an otherwise healthy individual the fracture should just about be healed. The definition of healed would be how it looks on x-ray and how it "feels" clinically, meaning sometimes the bone may not be completely closed on x-ray but there is no pain on walking or pressing on the area.
Speak to your doctor about this.
Marc Mitnick DPM

swelling post ankle ligament repair

by Kelly H
(Ashland, KY, USA)

I injured my lt ankle on 4/25/09. An MRI showed ATF complete tear and a partial tear of the calcaneofibular ligament. I had an ATF ligament repair on 8/17/09. Post-op report stated granular tissue formation at the calcaneofibular ligament. I was on crutches for 10 days. Changed to a walking air cast for 6 weeks. Began PT at 8wks post-op. PT 3x/wk for 2 wks. I was pain free the entire time in the air cast. I am currently having pain and swelling behind the ankle bone (outside). I am 10 wks post-op. Is this nml?

Hi Kelly,
The best way I think to guage post operative progress is asking yourself this simple question: "is the injured area getting better each week?" If you notice some progress each week then you are on your way. If you reach a point where there is no further progress then that might indicate you have a problem.
It sounds like you may have reached that point. My best advice to you would be to contact your surgeon for a follow up visit and let he or she assess your progress. You may need a walking brace to help you along until you are completely healed.
Marc Mitnick DPM

possible ankle sprain or fracture

by Jillian
(Wichita, Kansas, US)

A few months ago, I fell down about 3 concrete stairs and landed in a squatting position with by knee out in front of my ankle. It hurt the first three days or so; however I could bear weight on it. It would only pop a little when I walk and rotate it. My dad used to be a pediatric doctor, and he said that there's most likely nothing wrong. My family and I didn't want to have to go through the pain of MRI scans since I'm a dancer. We were afraid that my doctor would tell me to stay off it for too long. Now it's about 6 months later and I still have a big of a popping sensation. My friend who plays football told me that I'm most likely experiencing the scar tissue from a minor sprain. However, I can't be sure. However, I cannot get it checked out before fall cheerleading, for my doctor will most likely tell me to get an MRI and stay off of it for a few weeks. Another fun fact- My ankle feels relatively fine during my cheer jump conditioning practice. As a medical professional, can you please try to tell me if you feel there is any serious damage. You might think this sounds crazy, but I'm a dancer, and my feet and ankle are important to me. I know I should've gone in immediately to get an MRI scan, but neither I nor my family could deal with that. Would it be safe to go one sports season without an MRI? Do you feel it would be safe to for me to cheerlead as long as I don't fly or tumble?

Jillian,
Here is your problem in a nutshell. If you have a serious problem you cannot make believe it is not there. In order to get it better you will have to seek medical care and that may require some time off from dance.
If you continue to avoid treatment, the problem may get worse to the point where it will not be able to be remedied.
Marc Mitnick DPM

Heel pain where I stepped on a nail

by Steve
(Syracuse, New York)

About 3 months ago I stepped on a nail, the nail penetrated the outer bottom side of my right heel. The pain went away in a couple weeks with no infection and I felt fine but the pain started to bother me two months later at the point where the nail went in. The pain now is continuous and is very similar to what it felt when I stepped on the nail originally. It's very tender with a burning feeling only at the nail spot. Several weeks ago I visited my regular doctor who recommended an x-ray the picture did not show anything in there or any signs of infection. I next went to a foot doctor who suggested that there exists a fibrous tissue in the spot where the nail went in, he removed the tissue approximately 3/32" deep and 1/8" in diameter it healed and I had some temporary relief. Prior to that visit he applied an acid to remove the callous like build up which had developed on and near the surface where the injury was. This also gave some temporary relief but the pain has returned. I have tried scraping the area to remove as much of the hard tissue I can and I have to wear a round cushion with a hole in the center, soft thick socks and tennis shoes other wise the pain becomes very intense. I have trouble walking on this foot. This problem feels like there may be a build up of hard tissue or possibly scar tissue deeper in this area causing pressure on a nerve. I've tried soaking, hot and cold packs with no improvement. The slightest touch to the injured area causes pain even when I lay down to sleep. I want to go back the the Doctor who did the surgery but he did say he had never experienced this sort of problem before and wasn't sure what he could do further. I'm looking for any suggestions,this problem has really got me down I am an active person.

Hi Steve,
As a precautionary measure I would consider having a bone scan to make sure the nail did not hit the bone and cause a bone infection. Generally the foot would be hot and tender but you never know. An xray will not help in this situation.
If the bone is not infected then I agree that you did some soft tissue injury to the bottom of the heel. If there is thick skin growing, you might ask your podiatrist for a prescription for a keratolytic agent like sal acid to be applied twice a day in an effort to macerate and soften up the area; you may experience relief from that.
Marc Mitnick DPM

FRACTURED MY LATERAL MALLELOUS HOW LONG AFTER I GET OUT OF MY AIRCAST CAN I GO BACK TO WORK?

by Jason T Shaffer
(HOPWOOD ,PA)

I FRACTURED MY LATERAL MALLELOUS ON MAY 8TH @MY 5WK CHECK UP IT WAS A LITTLE CLOUDY AS IF ITS HEALING SLOW !I'M IN A AIRCAST I CAN ONLY TAKE IT OF IN THE HOUSE!I'M GOING TO P.T.TODAY WILL BE MY 5TH VISIT THE MOBILITY IS GREAT STILL SWELLED!HOW LONG AFTER I GET OUT OF THE AIRCAST WILL I BE ABLE TO GO BACK TO WORK !I'M ON MY FEET ABOUT 10 TO 12 HOURS A DAY ! THIS ISNT THE BEST PIC ITS NOT THAT CLEAR BUT THERE IS QUITEA GAP WHERE ITS BROKE YOU CAN'T SEE IT THAT GOOD!THE GAP IS ALMOST 1/8OF AN INCH!

Hi Jason,
I do not know how old you are, your weight, your occupation, your general health, whether or not you smoke, etc. all of which play into how long this is going to take to heal. The other thing that bothers me is that it is now two months since the fracture and it does not appear to be "well on its way" to closing, keeping in mind that I am looking at a very poor picture of your x-ray.
I do not like to second guess other doctors because I do not know the full details but when you say Air Cast I hope you mean a full cast and not just a brace that they make for sprained ankles. In order for the break to completely heal, it needs to be full immobilized and you need to be off it as much as possible.
My best piece of advice is to discuss your concerns with your doctor; he or she is better equipped to adequately assess your progress and give you a better prognosis.
Marc Mitnick DPM

Pain in arch, scar tissue

by Kelly
(St. Louis)

I am a runner, and I have recently started having pain in my arch of my right foot, I have a lump that was left from an accident when I was young, I stepped on a large piece of glass, that cut through the soft tissue of my arch, and left what I am thinking is now scar tissue (the lump)? Could I just have planta fascitis that is hurting my arch or could it be the scar tissue alone? It does hurt worse after rest. But if I roll my foot over a ball to massage the muscle I definately feel pain RIGHT at the spot my scar is. Any suggestions would be much appreciated. As I do love to run, and it is increasing in pain.

Hi Kelly,
My first thought would be the scar is causing your pain. The odds of having plantarfasciitis in exactly the same place as your scar is pretty much nil (unless the original cut was so deep, it affected the plantarfascial ligament).
Depending on how big, deep and where it is actually located, one option might be to have the scar excised. Injections into the area may also be helpful.
I would suggest you see either a podiatrist or perhaps a plastic surgeon in your area to have the scar properly evaluated.
Marc Mitnick DPM

Difficult to find an expert! Hit by a car, rear of foot causing foot pain after 2 years.

by Rossitza Jones
(Spain)

Dear Dr Mitnick

This question is referring to some suggested treatments of CRPS or RSD.

Considering temporary sympathetic blocks, I understand they are designed to “temporarily suppress the activity of the sympathetic nervous system”. Since the effect only lasts for short periods of time, why are then further blocks given as a “course of treatment”!?
How does a “permanent block” work, which in fact means surgically interrupting the sympathetic nerves or disabling them by an injection? Since some of their functions include the regulation of blood flow and skin to the limb, how could this disruption affect the functioning of the limb afterwards?
I often hear from the information on RSD, that the results of such surgery could often be very disappointing. Could you, please, comment on the potential risks as well as any benefits; What is the success rate?
In your article on the subject, you mention that “Peripheral nerve blocks may be performed to break up the ongoing pain…” Does this refer to “permanent blocks” only? And why “peripheral” as opposed to “sympathetic”?
Also: Has the use of TENS-unit being found to be actually able to break the pain cycle? I remember the doctor, who performed my EMG making a comment that the TENS unit could only be beneficial to the peripheral nerves, but not for the sympathetic.

Thanking you

Sincerely yours

Rossitza Jones - SPAIN

Hi Rossitza,
Keeping in mind that I am not a neurologist I can tell you that sympathectomies whereby the nerve is actually severed generally do not work and cause a host of other problems because there is no longer a sympathetic nerve running down the leg.
Sympathetic blocks on the other hand, are only temporary, with the idea of trying to break the brain to injured area cycle of malfunctioning signals. Since it is only tempoarary, repeated injections would have to be given with the hopes that at some point the problem might be resolved.
Tens units are not used for sympathetic nerves, they are used for sensory nerves. I have tried Tens units over the years and have never been particularly impressed by their success rate.
CRPS is very difficult to treat particularly when it becomes chronic.
If you cannot find an expert where you live, consider traveling elsewhere. This is a condition that needs proper treatment.
Marc Mitnick DPM

Sprained Ankle, I think....

by Erin

6/12/2009

On May 28th I feel down my stairs. I tripped on the 4th stair from the bottom and the first part of my body to "brace the fall" was my left foot. I landed on the outer side of my foot (bottom of my foot was facing towards my right foot). I heard a very loud pop and in comparison to the numerous bones I have broken this by far hurt the worst.

I went to the minor care emergency center within 45 minutes of the fall. I was seen by a PA who did not compare my injured ankle to my normal ankle. The reason I mention this is because I really do have tiny ankles. So, what looked "normal" to her after falling 45 minutes (or more likely an hour and half or more, after the fall i.e. the wait), was double the size of my normal ankle. However, she said she was ordering x-rays so I thought that even if she failed to properly examine me then, if anything were seriously wrong she would see them on the x-ray.

She told me that she didn't see any breaks or fractures on the x-ray but, a radiologist would be looking at it for a second opinion. She did put me in a walking boot and then sent me home. I received a call later that day stating that the radiologist agreed with her diagnosis. I was satisfied and assured at this point that I would only need to wear the boot for a week as they had told me.

It has now been 15 days and my ankle has swollen worse (I have been using the "rest" method as well as religiously wearing my boot) and it actually seems to hurt just as badly as it did on day 3 and the swelling (which is right above my ankle) has not changed. I can walk on it for short periods of time on a flat surface but walking down stairs or trying to bend my foot forward (like a ballet dancer) causes immense pain.

Should I be using an ace bandage or taping it along with wearing the boot? (I only walk on it maybe a combined 4 hours every day). Does this sound like a sprain? Do you recommend that I see an orthopedist?

I'm just concerned that I haven't seen any improvement and would rather be pro-active now then find out 2 months later that I should have done.... Or, that my injury requires surgery (and did from the start) and at that point I could have been 2 months into my recovery.

Thank you for your help!

Erin

Hi Erin,
Just because there is no fracture does not mean that the ankle will simply heal in short order. I would be concerned about the possibility of a ligament tear which in some cases can be as bad as a simple fracture. The simple fact that your ankle seems to be getting worse would be a cause for alarm.
Yes, I think you should see either an orthopedist or a podiatrist because you are doing very little walking, you are wearing an ankle brace and your ankle appears to be getting worse.
Marc Mitnick DPM

metal screws and plate inside of ankle

by Jelisa
(Oxon hill, MD. US)

i have a metal plate inside of my left ankle along with screws when i broke my ankle two years ago. It gives me alot of pain and i was wondering if i could have surgery at this point to have it removed?

Hi Jelisa,
Although they initially serve a purpose, implanted hardware in many instances can become painful over time.
Your best bet would be to see a local surgeon, preferably the one who implanted the hardware and speak to he or she about having it removed.
Marc Mitnick DPM

Concerns about 5th metatarsal fracture

by Quana
(Oklahoma City, OK)

Three weeks ago I stepped off of a curb, twisted my ankle, and broke my 5th metatarsal bone. I went to the ER that evening and the break was confirmed by x-ray. The ER doctor said that the break was in a place that sometimes has problems uniting and may need surgery. He put a fiberglass splint on my foot with instructions to see an orthopedist in 2 to 3 days. He said that I should not put any weight on my foot.

Because I have an HMO, I had to see my primary care physician to get a referral to an orthopedist. Without seeing the x-rays, my PCP said that I didn't need a referral to an orthopedist. She took me out of the splint and put me in an aircast boot and said I can walk as tolerated. She also ordered another set of x-rays. When she got the report on the x-rays, she said that the fracture is aligned well, but still needs to heal. She left me in the aircast boot, again with instructions to walk as tolerated.

My concern is that I am still have quite a bit of pain after 3 weeks. I do not know if I have an avulsion fracture, a Jones fracture, or a shaft fracture. Based on what the ER doctor said, I suspect that I may have a Jones fracture and should not be putting any weight on it. My PCP did say that it is a serious injury and can take up to 2 to 3 months to completely heal. I can't decide whether to go back to my PCP and ask for a referral to an orthopedist or wait until the next set of x-rays in 4 weeks to see if it is healing properly.

Hi Quana,
In my opinion your PCP is not the expert in these types of fractures. A fifth metatarsal base fracture has a high incidence of nonunion (nonhealing fracture), so much so that most insurance companies will allow for the use of a bone stimulator almost immediately rather than waiting 6-9 months as used to be the case.
I would not recommend bearing weight on it until it is adequately assessed by an orthopedist or a podiatrist.
Marc Mitnick DPM

Pain and swelling in foot from snake bite

by Candy
(Texas)

I was bitten by a copperhead snake on the arch of my foot. (I was wearing sandals and it got my bare skin.)

I was put in the hospital for a week and went home with a huge foot and strong antibiotics. Because it really is rare to be bitten, I would like to know what I need to worry about. The ER doctor said I have to watch to make sure that I don't get gangrene, but what colors are good colors to see? My foot is extremely hot and I keep it on ice 24/7 and keep it eleveated for most of the day (propped up on a footrest while I work). But the toes sometimes look black and the foot is really really red and almost purple in places.

I live in the country in Texas and this was not something seen every day and even my husband's family doctor said he'd only seen 2 snake bites in 20 years.

So, I would like to make sure I don't over-react to the colors but I don't want to assume that the colors are normal either. Couldn't find enough online about treatment After the bite, so thought I'd see what this site could tell me.

Hi Candy,
Here in New Jersey we never see snake bites so I do not know how helpful I can be. The only advice I can offer is to follow your symptoms. In other words if the symptoms seem to be diminishing little by little then you are probably OK, but if the symptoms are not resolving and perhaps even worsening, you need to bring this to the attention of your doctor.
Marc Mitnick DPM

Glass stuck in foot

by william
(detroit)

about a month ago i got some glass stuck in my foot i removed it and thought that was that,but over the week i noticed that the sore wouldn't close over and now it hurts when i walk on it. i tried to reopen it with a sterilized sewing needle but i can't see it and it hurts too much.i don't have insurance and can't afford to go to the doctor.what can i do about this.it's right in the middle of my foot.please help

Hi William,
I understand your problem but I think you are going to need help getting out any remaining glass that may be still inside. If you know anyone who is a nurse or EMT specialist you might ask them for some help.
The problem here is that if the foot gets infected and "blows up" on you a visit to a doctor is going to pale compared to the medical expenses you will incur by being hospitalized.
Have someone help you get it out.
Marc Mitnick DPM

Broken big toe near growth plate

by Rocky
(Reno, NV)

Daughter (12yo) broke big to near growth plate in July. Had a boot on till sept and it felt better. Running around and jammed it in her shoe and hurt it again. Not sure if she re broke it. Orthopediast has no clue why it still hurts in Nov? She still has pain in it. Shooting pain as she states. Did MRI and nothing besides the broken bone is damaged.
She is very athletic and this is bumming her out. Missing out on everything for her first year in middle school.

What needs to be done and why is she still having pain?

Hi Rocky,
Your daughter is too young to do a bone scan which is done many times to look for a small fracture, so you might want to have another set of eyes look at the MRI.
If nothing can be found, then unfortunately the only thing I can think of is to immobilize the toe for a period of time until it heals itself, the assumption being that if the MRI does not show any major pathology, then rest and immobilization should do the trick.
Marc Mitnick DPM

fractured baby toe at proximal phalanx

by vanessa navarre
(denham springs, la. )

Hi,
About 3 weeks ago I fractured my baby toe for the second time. My orthopedic said it was broke at the proximal phalanx. I wore a boot for 14 days and then an ortho shoe. It is still very swollen, painful, and has an intense burning pain. It hurts to walk on it. Is this normal?

Thanks so much.

Hi Vanessa,

No this is not normal, the toe should be getting better after 3 weeks, although not necessarily healed.
I find that splinting the broken toe to the adjacent toe offers more stability than wearing a cast boot.
Speak to your doctor about taping it rather than wearing the boot.
Marc Mitnick DPM

Foot injury

by Linda
(New York State)

I fell at work on 1/19/09 and somehow twisted my foot which I didn't realize at the time. I went to the Emergency room at my local hospital and had x-rays taken and no fractures of tears were seen. Foot has been swollen since that time and I've even had a MRI just to be sure and seen by an orthopedic doctor and he's baffled and has no answers why the foot is still swollen after all this time. I was given a support stocking and a walking boot but it's still swollen. When I go to bed at night and the foot is elevated all night the swelling is almost gone in the morning but is still noticable. What else can I do? I would like to get back to normal.

Hi Linda,
Swelling that is apparent during the day but diminishes at night only to return when you start walking may be a sign of poor venous return, the blood is having trouble returning to the heart. This can be due to varicose veins or being overweight as simple examples.
Why not see a vascular specialist to examine you just to make sure there is no vascular problem. If your MRI is normal then I do not think it is coming from your original injury.
Marc Mitnick DPM

talus avulsion fractures

by Denise
(Shadyside Ohio)

I have 3 avulsion fractures of the right talus. I am seeing a foot doctor. He has put me in a boot cast (brace)and I have had to use crutches for the past 2 weeks. What can I expect for the rest of my treatment and how long does the treatment usually last?

Hi Denise,
I do not know your age or the severity of the fracture. Avulsion means a small piece of bone has been fractured off the larger bone.
Assuming the fractures are small and they heal uneventfully, you are looking at 6-8 weeks under normal circumstances. Your smart move would be to discuss this with your doctor as he should be able to give you a better estimate based on x-ray observation, and your overall health status.
Marc Mitnick DPM

reoccuring bruise

about a month ago over a couple of day my big toe, left foot became discolored then blueish and finally it was a horrible black...soaked it in white vinegar and epsom salt... it was a little pus and the nail lifted...pressed and it drained ...soaked it the next day and drained a little more...the nailed came off and has started to grow back...i noticed yesterday its getting discolored again down near the cuticle and there is soreness...i dont remember bumping it the first time or now and have been wearing flip flop since...

Hi,
Sounds like it is probably getting infected again. Your best bet would be to see a podiatrist and have the toe properly cared for.
Marc Mitnick DPM

chronic pain following fifth metatarsal fracture

by Ann
(Toronto, Ontario, Canada)

I fractured the fifth metatarsal of my right foot in 2006 and was casted for 20 weeks. I had no physiotherapy following removal of the cast and experienced pain, tenderness and impaired temperature sense for some time thereafter. While the acute effects dissipated over time, I continue to have pain in the area of the fracture. I saw a podiatrist several months ago who x-rayed the foot and showed that the fracture was completely healed; he suggested orthotics. I am wondering, however, what is ailing me? It feels as if there is a band of tissue across this area that is often stiff and sore (the way your foot flexes when driving particularly brings this on).

Hi Ann,
Even though the x-ray revealed no fracture I would suggest you have either a bone scan or an MRI to be sure there is no fracture. The fact that you are still having pain is reason for concern.
You do not mention what part of the fifth metatarsal was fractured but if it was the fifth metatarsal base, that is a historically poor healer, due to the diminished blood supply to the area, and so there is the possibility that it is not completely healed in spite of the recent x-ray.
Marc Mitnick DPM

Jone's fracture of L foot

Today is 7 weeks since acute injury diagnosed as a Jones fracture of my left foot.
Initially I had a slab cast on, then aircast but couldn't sleep at night with it on (too bulky) and too uncomfortable without it, even if wrapped in a tensor, so...had fiberglass cast for three weeks. Now back to aircast with feather weight for two weeks. Non-wt until that point. Then re-xray. I continued to work full time the first 3 weeks of injury by pushing myself on a desk chair. This certainly wasn't ideal but there was no coverage in my job. I would like to know what is normal healing at this point....my foot turns purple within minutes of being down, ball of foot feels like it has a tight band around it and pins and needles particulary of great toe. If foot is down for extended period (working some days still) it is cold and numb. Takes hours to warm up. Is this normal?
Thank you in advance for your input.
Paula

Hi Paula,
Read my section on foot fractures and you will see Jones fracture (fifth metatarsal base fractures) can be very, very slow healing fractures because of the poor blood supply to that area.
What bothers me more are symptoms you are describing. Read my section on CRPS; this is very important. I would suggest you discuss this possibility with the doctor who is treating you because even though I cannot possibly make a diagnosis like this without ever actually seeing you, but this is potentially a very serious problem and it should be addressed. Do not delay.
Marc Mitnick DPM