severe pain in left foot

by Gary
(Grand Rapids, MI USA)

I slipped and fell in the bathroom one morning about a week ago, and the front (toe portion) slammed into the door jam causing much pain. I even went to get X-rays done, but they were negative for fractured bones. However, my foot still continues to give me a good deal of pain. I am on the verge of going to see my doctor to see if he can do better than the folks at the hospital emergency room.

One thing which helps it feel somewhat better is Tylenol (2 pills). When I ran out of Tylenol recently, I switched to some Ibuprophen in my medicine cabinet, but it doesn't do as good a job of relieving the pain. I'm thinking of asking my doctor for a shot of Cortisone. I am usually a pretty fast healer, but this is not showing any signs of improvement. One last point, and it just may be more of a contributor than I think --- with the use of a cane, I am doing more walking than would probably be suggested. I live in a retirement apartment building, and just getting from room to room at times is probably more than would be suggested. However, since I'm alone in my apartment, a good deal of it is hard to avoid.

Thanks for any helpful advice you can give! MERRY CHRISTMAS!!!





Gary
(I just turned 71 in November, but look and feel 2 decades younger)

(Sorry, but I don't have any photos)

RESPONSE

Hi Gary,

I do not really need pictures in this instance as I would guess in worst case scenario your foot may be a little swollen and tender to touch.

As I state on this site time after time, the problem with foot injuries is the fact that you have to walk on your foot and that usually exacerbates the problem, particularly in delaying the healing process.

If you had suffered a similar injury to your hand, you could have put it in a sling, avoided using it as much as possible and it would have been well on its way to healing.

Another problem is gravity. When you walk on an injured foot, the foot is naturally swollen because of the injury, but gravity causes more swelling by forcing more blood into the foot and that is one of the reasons it hurts so much to walk. That is also why elevation of your foot probably makes it feel somewhat better.

The fact that Tylenol works better than Ibuprofen is neither here nor there simply because some pain medications work better on certain people than others. That is why there are a million pain relievers on the market. Quite frankly if the Tylenol is working, you are much better off with that.

If you came into my office asking for a shot of cortisone, I would probably talk you out of it for a couple of reasons. First, cortisone reduces inflammation and yes, that might make the foot feel somewhat better, but it also delays healing.

Secondly, we are still dealing with the possibility of a fracture that may have been missed on the initial x-ray, and if there is a fracture, a cortisone shot would be counter intuitive.

My advice at this point is that it has only been a week since the injury which is not very long particularly in an older individual. We can also assume if there is a fracture of any kind it is probably nothing more than a "crack" in the bone and is non-displaced; if it were anything worse, I cannot imagine the ER physician or Radiologist who eventually reads the x-ray, missing it.

Assuming you are overall a healthy 71 year old who has no walking issues, I would put you into either a surgical shoe or walking boot which will better protect your foot than a regular shoe. Your doctor can decide if he or she thinks you will be able to walk without difficulty with either device.

I would continue with the Tylenol as needed for pain, try and rest the foot as much as possible over the course of the next ten days, then re-evaluate your situation. If you find that you are starting to improve, although perhaps not totally resolved, I would continue with that course of action. As a side note, you might even consider adding some physical therapy to the above mentioned regimen.

If after the next ten days, you are essentially no better off than you are now, in my mind that would be cause for concern and further medical investigation. I would suggest that if further investigation is necessary, you see a podiatrist or an orthopedist as they will be able to do a better job than your family doctor.

Merry Christmas.

Marc Mitnick DPM
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