Hard blow to top of foot

by Casey
(Conroe tx)

10 days ago I dropped a jack stand on the top of my foot, I immediately did the r.i.c.e. technique, I waited 2 days to go to the er,but it started to bruise and swell pretty bad, xray showed no signs of break ,he said I just bruised everything pretty good..he wrapped with ace bandage and gave me crutches,and said I can use it and put weight on it when I was comfortable . Well 6 days after the drop I finally could put weight on it and walk with a slight limp.still no shoe due to bruising an a little swelling.on 8th day all swelling gone, still black and blue but starting to go away slowly now here we are on 10th day and foot feels better still sore but 3 of my toes are staying black and blue and one real red,hurts really bad seems like the bruising lightens if my foot is elevated above my heart but as soon as it's not elevated it gets dark bruising again and hurts to put any pressure on it..my middle toe feels heavy and fat hard to explain..and kinda stiff..help I had to call into work today cause I'm in so much pain

RESPONSE

Hi Casey,

If I am reading your narrative correctly, it seems like your foot was starting to get better as you were able to bear more weight on the foot and it was also looking better. Then it apparently started to worsen as there is more pain and the discoloration is also worsening, although it appears better if the foot is elevated.

Now the pain is so bad you cannot walk on the foot and so could not go to work.

My first thought is that you simply are not ready to start walking on the foot and although you were able to walk in limited episodes, when you are called upon to walk normally so that you can function at work, you are not able to do so. I am making the assumption that up to day 10 you were only walking in small bursts and not really putting your foot to the "test".

In the vast majority of cases that would be the situation, you simply are not ready to walk on a prolonged schedule.

After the first 24 hours I would stopped with the ice and switched to moist heat. The problem with ice is that although it helps reduce pain, it also delays healing as it reduces blood flow to the injured area and it is blood which brings nutrients to help heal. For that reason I recommend ice for only the first 24 hours after injury and have my patients switch to moist heat, not something like a heating pad.

I would have also put you on some anti-inflammatory medication to reduce the inflammation which would have moved the healing process along quicker. You do not mention if you are taking any medication and of course, this assumes you can tolerate anti-inflammatory medication

On the top of the foot you have tendons, blood vessels and nerves. It is safe to say that you did damage to some if not all of those structures with the assumption there is no chipped bone, which cannot be ruled out simply because small fractures may not show up initially on x-ray.

Your pain may be due to damage to the tendons which in most cases would make it difficult to put on a closed shoe as the pressure of the top of shoe would be pressing against the tendons.

The only thing that concerns me in your narrative is the discoloration that you describe. If my understanding is correct, the discoloration is actually worsening. In foot trauma, there can be discoloration, but it should improve as time passes, not worsen.

With that in mind, there is the possibility you did damage to one of the superficial veins on top of the foot and may have what is know as a phlebitis, as I have seen this on a few occasions over the years. This is something that needs to be treated.

My best advice would be to see a doctor in your area and let he or she assess your problem and give you guidance going forward. Just trying to put up with the pain will probably accomplish nothing more then delaying the healing.

Marc Mitnick DPM
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