injured foot 7wks no change

I fell off a curb and hurt my foot...went to the ER that day and they said no break but did have a severe sprain...then 5 wks later went to orthopedic because still couldnt put weight on it at all...they did more xrays but still couldnt see a break but was very concerned why I was still in so much pain still couldnt walk on it...they gave me a walking boot and they scheduled an MRI but even with insurance it was too expensive....its been 7wks and I can put a little weight on it without the boot but still having a lot of pain and a lot of swelling even when I wear the boot....Any advice would be great...

RESPONSE

Hi,

Unfortunately, without an MRI your doctor has no idea what is actually going on, if anything.

The fact that it has been seven weeks and your are still in a lot of pain is a concern. You "only" stepped off a curb, so in theory how much damage could you have done to your foot and ankle? That is why it is surprising that you are still in pain.

You have had two sets of x-rays and there is no sign of fracture. The importance here is that small fractures may not initially show up on an initial x-ray, but in theory would show up on the follow up x-ray.

Based on that you can assume your pain is all soft tissue in nature, meaning it is a result of damage to a soft tissue structure in your foot and ankle and not from a bone injury.

The problem here is that without an MRI your doctor does not know what soft tissue is damaged and to what extent.

In theory at least you could have damaged a ligament or tendon in the foot and in a worse case scenario you may have actually torn a ligament or tendon. An MRI would probably have pointed that out.

So, what are your options?

The way I see it, the best thing you could do would be to go non-weightbearing on the foot with the use of crutches. The walking boot attempts to immobilize all the structures in your foot and ankle in an effort to make it easier to walk, but even with the walking boot you are still straining something in your foot and thus are still having pain. By straining whatever structure hurts, you are delaying the healing, particularly if there is a tear of some sort.

By going non-weightbearing, you no longer are straining any structures in the foot and ankle and that will allow you to heal quicker.

The one problem with this recommendation is if there is actually a tear of some sort. In most cases, if the tear is severe enough it may have required surgery, but of course no doctor can know if there is a tear without an MRI.

So, although most ligament or tendon tears will heal over time, they may heal with excessive scar tissue which could lead to residual problems down the road. Adding insult to injury is the fact that you might go non-weightbearing for three of four weeks and still find yourself in pain, so all you have done is wasted that period of time.

You might also ask your doctor about the possibility of physical therapy in an effort to move the healing process along. Therapy is very good at reducing pain, swelling and inflammation but once again if there is a tear of some sort it may end up actually making the problem worse.

If I can make the assumption that you are relatively young, in good health and are still having substantial pain seven weeks after abnormally stepping off a curb, then I would be concerned about a more serious problem such as a ligament or tendon tear going on in your foot. This is not a simple strain. Most people who suffer a simple foot or ankle strain are usually at least 50 percent better in a week and 90-100 percent better after two weeks.

So....if you are still in as much pain as you were weeks ago, you may have to bite the bullet and have the MRI.

Marc Mitnick DPM
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