trauma to foot

by Sean
(Belfast, N.Ireland)

Hi,

10 months ago my foot got kicked when it was dragging the football back, my foot was on the ground at the time and my weight was on it. The pain was extreme, I felt like I had broken it though strangely enough the impact wasn't that big, my friends were surprised and so was I at how much discomfort I was in. Over the next few days it was quite swollen but the hospital said it was a sprain. However, after months of foot exercises, to help recover my movement, certain movements still bring on that pain, or a twinge of that pain. My doctor told me to lay off sport, so I did and after a 6 month break (my foot still felt the same) I decided to play and when I kicked the ball with the side of my foot that niggling pain slowly crept back. The thing is I could kick the ball with the side of my foot np but after that match my foot felt extremely painful.

The pain is centred around the Talus bone/traverse tarsal joint/navicular bone area, basically when I press into that area with my finger its extremely sore. If I rest for a while the pain dies down but never fully goes away - it is always agitated by certain movements of the foot such as twisting certain ways, I cannot go right up on my tiptoes on that foot (my right foot). It feels as though something needs to be popped/pulled back into place but my doctor tells me its fine but he said the exact same thing 8 months prior when he told me rest would cure it, I'm beginning to think he is wrong but what can I do since he's the qualified one?

To provide a quick timeline:
- 10 months ago I picked up the injury
- Few days later went to hopsital they told me sprain and gave me exercises
- I completed the exercises but things weren't right
- I visisted doctor 2 month after injury he told me rest
- 8 months later I play a game and could kick the ball with side of foot though after a miskick the pain came back with a vengeancem I finished the match but hobbled off, that was a few days ago and now it feels slightly better but again that niggling feeling is still there.

Any help would be really great.

Thanks,
Sean

RESPONSE

Hi Sean,

You do not mention it, but I assume at the very least your foot was x-rayed when you first went to the hospital.
Assuming there was no fracture then one can assume a soft tissue injury of some sort. The fact that so much time as passed, the fact that you have rested the foot and the fact that you are probably reasonably young and yet your foot still hurts, means there is something more going on than just a sprain.
If you were in my office I would order an MRI which would tell us the extent of soft tissue damage (damage other than bone). Usually, when there is this much pain one has to look for ligament or tendon damage.
If an MRI is not an option for you as I do not know what your health care system allows, then you have two options.
1. The first option would be to have the foot immobilized and even possibly go non-weightbearing for a month or so in an effort to allow the soft tissue to completely heal.
2. Go for physical therapy in an effort to rehabilitate the injury.
The problem here is that since I cannot examine you I do not know the extent of your injury and so cannot tell you which course would be best for you. The fact that so much time has passed tells us this problem is not going away on its own.
So in light of that, I would suggest you speak to your doctor, get a specific diagnosis, and ask he or she which course of therapy would be best.

Marc Mitnick DPM
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