Top, mid foot pain 6 weeks after injury

by Beth
(Cincinnati, OH, USA)

6 weeks ago I dropped an outdoor grill weighing approximately 100lbs on the top of my foot. It immediately bruised and swelled. After several days of icing, ibuprofen and letting it rest it felt better. Over the past couple of weeks I have been on my feet a lot with the injured one beginning to ache, tingle and just feel different. When to Urgent Care for X-rays. She suspected a break at the 3rd metatarsal and recommended me to an ortho. Went to the ortho with the X-rays from urgent care. He did not see a break and is attributing the pain and discomfort to tendon and soft tissue injuries one would experience from a crush injury. He recommended a short cam boot. I have been wearing the boot religiously. While my foot feels better the top feels like it needs to pop. Is this normal and is wearing a boot to heal a soft tissue/tendon injury the right approach?

RESPONSE

Hi Beth,

Obviously, dropping a one hundred pound object on your foot has to do some type of damage. You have had two people look at the x-ray and can probably assume there is no break (but you never know). So, assuming there is no break it is quite obvious you had soft tissue damage of some sort. "Soft tissue" is everything other then bone.

The reason the orthopedist suggested the boot is to keep the foot immobilized. By being immobilized a couple of things are happening.

One is that you do not have much pressure pressing on top of the foot and that allows the soft tissue to heal.

Secondly, by being immobilized the foot does not move when you walk and this prevents the tendons on top of your foot from moving up and down. Movement of the tendons would only aggravate any of the tendons that are damaged. So essentially, you are resting the tendons.

Now I do differ in my overall opinion of just wearing a boot. I think there are things you could do to move this issue along.

The first would be physical therapy. If there is only soft tissue damage to the top of your foot, physical therapy would go a long way in reducing the pain and resolving your problem. I would suggest some of the modalities like ultrasound or cold laser treatments to improve blood flow to the area, as it is blood that brings nutrients to the area to heal damaged tissue.

I would stay away from physical therapy that looks to exercise the damaged tendons as it my feeling that only exacerbates the problem and unfortunately most physical therapists would probably insist on that type of treatment, as well as some form of heat therapy.

If physical therapy is not available to you due to insurance reasons, then at the very least I would recommend moist heat applications to the top of your foot. Using a hot/cold pack placed in a microwave or boiling water would allow you to deliver moist heat to the painful area. A heating pad is not a good alternative.

The last issue I would like to address is the tingling that you mentioned. Along with the tendons and blood vessels that travel along the top of your foot, there are nerves, specifically superficial sensory nerves. The intermediate dorsal cutaneous nerve passes right over the center top of your foot.

Tingling in the damaged area may represent trauma to this nerve. This nerve can be traumatized simply by continually lacing your shoes too tight, so you can imagine what a 100 pound object could do.

If the tingling is still there and you can test it by tapping your finger over the painful area and seeing if that creates a tingling sensation or sends "electrical" like sensations down your foot.

This would be known as a neuritis of this particular nerve. The best way to treat that would be to go back to the orthopedist and a doctor who might be more familiar with the workings of the foot, and have a cortisone injection into the area.

Marc Mitnick DPM
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