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

heel pain when walking and swelling below ankle bone on outside of foot (right).

While on vacation, I jumped off of a rock onto a rock landing that was approximately 3 feet high. I was wearing flip flops. When I landed on my feet I fell back onto my butt. My right heel hurt initially but not really that bad. I got up and walked off and continued to enjoy the rest of my week vacation. Some discomfort but not too bad. Once I got home my heel continued to feel worse. To the point where I am walking very slowly with a limp. The pain is in the heel when I go to step forward. I do have some moderate swelling below the ankle bone on the outside of my foot. Did have it xrayed when I got home from vacation but it didn't show a fracture. However it is now almost 2 1/2 weeks and the pain is getting worse no better. Is there anything that could be getting missed and is there something I can do to help my walking and pain?

RESPONSE

Hi,
The heel bone can be a difficult bone to identify pathology with simply by x-ray. The fact there was trauma to the heel always raises the possibility of a fracture.
There are various types of fractures that can occur, but the calcaneus (heel bone) is notorious for compression fractures where the bone actually caves in a bit. This type of fracture can be difficult to diagnose with a simple x-ray.
Also fractures of calcaneus facet (where the calcaneus attaches to the talus bone above it) can also be very difficult to diagnosis with a simple x-ray.
Adding to the problem is

the fact that sometimes very small fractures of any bone will not show up initially on x-ray and usually have to be repeated after ten days or so.
So, based on one simple x-ray, you cannot completely rule out a fracture of the heel bone.
I do not know how old you are but will assume you are relatively young.
Making this assumption I would have thought that just a bruise to your foot would be feeling much better after 2 1/2 weeks and obviously that is not the case. Actually, it sounds like the foot is getting worse as you are now forced to walk in a guarded gait.
I think the best piece of advice that I could give you would be to go back to your doctor, only if this doctor is a podiatrist or orthopedist. If you went to your family doctor for this problem, he or she is not the one to see for a follow up visit.
At this point an MRI or CT scan would be the better alternative to finding out what is causing your pain.
Both of these tests are more sensitive for fractures in bones then x-ray and they will also evaluate the condition of the soft tissue (everything but bone) that is in your heel.
Additionally, at the very least, until you have a specific diagnosis, I would recommend you get off the foot by using crutches. I do not know the extent of your injury since I do not have the luxury of examining you, but certainly continuing to walk on the foot is not doing you any good.

Marc Mitnick DPM
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American Academy of Pediatrics

Penn State Medical Center

National Institutes of Health

Columbia University Department of Rehabilitation

ScienceDirect

Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

Institute for Chronic Pain

University of Florida Health

American Family Physician

Cedars-Sinai

University of Maryland Medical Center

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Evansville, IA

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San Diego, CA

Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

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Albany, NY

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Jill S.

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Whichita, KS

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Boston, MA

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Colorado

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Colorado

Wonderful advice

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This is the best site for foot problem info.

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location unknown

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Wisconsin

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North Carolina

Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown

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Bessie Mae

Florida

Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

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New Jersey

Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

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Bellevue, WA

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Jodi

location unknown

heel pain when walking and swelling below ankle bone on outside of foot (right).

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