swelling

I was skateboarding and doing a trick. When i came down on the board to land my heel landed on the board and my toes hit the ground, stoping me dead and thrusting the center of my foot forward. I now have pain on the top, outside part of my foot and it has swelled up and affected my walking. My insurance won't cover a hospital trip and i can still limp around. With ice should this eventually get better?

RESPONSE

Hi,

I cannot answer whether or not ice alone will make your foot better for the simple reason we do not know the extent of damage done to your foot.
When my patients sustain an injury, I generally only recommend ice for the first 24 hours. After that I have my patients start applying heat.
The purpose of ice is to reduce the initial inflammation so the foot does not hurt as much, but heat, applied after the first 24 hours, increases blood flow to the injured area. It is our blood that carries nutrients to allow us to heal.
So, where does that leave you?
If you do not have insurance to cover an x-ray which you should have to see if you actually broke a bone, then you can wait 24 hours or so to see if the pain in the foot improves at all. When I say improves, I mean substantial improvement in the area of 50-75 percent improved. This would tell my that perhaps there is no broken bone and all the damage you did to yourself was "soft tissue" in nature meaning you probably damaged the ligaments or perhaps even the tendons that course through the foot.
To really be on the safe side, if you have access you crutches, I would recommend using them, so that you are non-weightbearing on this foot. This way, even if there is a broken bone, you are not doing any further damage to the foot if you do not bear weight on it.
Using an ace bandage as well will also help immobilize the foot and help prevent further damage as well as making the foot feel better.
Now, if after a day or so the foot really does not feel much improved over how it felt initially after the accident, then you are going to be forced to have an x-ray to rule out fracture.
If there happens to be a broken bone that goes undiagnosed this could end up causing you a lot of problems going forward.
The biggest issue would be what we refer to as a non-union, where the actual break never "knits" back together. This leads to chronic pain and in cases where the pain is intolerable, you may be looking as surgery as the only way to fix the problem. I should mention for the sake of completeness that we also use bone stimulators to heal broken bones, but they do not always work and they too are expensive.
So, in summary, give the foot 24 hours or so, stay off it, wrap it, use heat, but if there is not substantial improvement, then go get an x-ray and appropriate medical care.

Marc Mitnick DPM
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