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

top of foot injury from kicking

by David
(Durban)

injured foot

Hi,

I injured my foot playing soccer 3 weeks ago. The injury was from making a tackle and impacting with ball and person very hard with the top of my foot. I played the rest of the game as it didn't really hurt. After the game after cooling down, it started to hurt and swell up. I limped around for the next 2 days with a very sore foot, slightly swollen, no visible bruising. Swelling went down after a couple of days, and pain decreased. In the mornings, pain is minimal, at the end of the day after some walking around it is quite sore. When I apply pressure to the area(shown in pic) it is sore. I am walking normally 90% of the day.
Is my injury more likely bone or tissue related, and who is the best practitioner to see regarding my foot. I can't really afford to see multiple people and pay for multiple therapies.

Any advice, direction, diagnosis you could give would be much appreciated

Best Regards,
David

RESPONSE

Hi David,

The only way to know for sure if there a fracture of any kind is to have an x-ray. There is no way any doctor can just look at a foot and tell.

In terms of the doctor you should see, a podiatrist or an orthopedist are your best bet. Quite frankly, any other type of doctor would basically be a waste of time particularly if there are complications of any sort.

Your narrative is more suggestive of bruising and soft tissue injury than a fracture, but keep in mind I am just guessing.

The reason I think the foot may just be bruised rather than broken is because you state that the pain is not too bad early on in the day but by the

end of the day, after you have done some degree of walking, the foot will hurt more.

Usually in a fracture the foot will hurt from step one in the morning and hurt all day long. Yes, the pain will worsen during the day as well, but the point to be made is that the foot will also hurt significantly early in the day as well.

Looking at your picture and the area that you circled I would be inclined to think you may have done some damage to the tendons that bring your toes upward, as well as bringing your foot upward.

So, early in the day there may not be to much pain in the foot, but as the day progresses and you continue to walk, you are probably overworking these injured tendons, so by the end of the day your pain is more significant, due to the fact that the tendons have become more inflamed.

Your injury occurred three weeks ago and that concerns me in the sense that if you all had was a soft tissue injury, by now it should have at least greatly improved (although not totally resolved) and this time element may suggest the possibility of a more severe injury than just damage to your extensor tendons. I should point out that sometimes soft tissue injuries in the foot may take longer to heal than injuries elsewhere in the body for the simple reason that as you walk on the foot you are essentially re-injuring the injured tissue and this can delay the healing process.

Even though I am leaning towards a soft tissue injury over a fracture, the length of time that this has been going on does concern me and therefore, I would suggest you seek medical attention.

Marc Mitnick DPM
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Feb 25, 2014
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Thanks
by: David

Thanks very much for the information! Really appreciate it.
All the best,
Dave

Feb 23, 2014
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Nothing broken
by: Anonymous

Hi.
Thanks for the information. It sounds like you're on the right track. I had X rays and a CT scan. A radiologist in the family so haven't seen a therapist yet. No fracture showing.
When you mentioned the tendons bringing the toes up, I notice that flexing my toes up using foot muscles doesn't hurt? But pulling my toes up with my hand does. In particular it's only the one toe next to my big toe that hurts when I pull it up.pulling it up with my hands obviously extends further than using foot muscles only,but interesting to isolate the pain.
Do you still think tendons? What would be the treatment for it, the to do's and not to do's? And how long would you expect recovery time?
Many Thanks
David

Hi David,

If it ends up being diagnosed as tendonitis you have a few options. The simplest would be a round of anti-inflammatory medication, say perhaps for two weeks, with limited activity (nothing more than absolutely necessary ambulation), along with application of moist heat to the painful area. Moist heat is much better than dry heat such as in a heating pad.

If that does not seem to speed things along, then I would suggest you consider a cortisone injection into the area. They tend to work quite well.

A last option would be rigorous physical therapy, but I generally find that is not necessary.

Marc Mitnick DPM

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Columbia University Department of Rehabilitation

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Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

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University of Florida Health

American Family Physician

Cedars-Sinai

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