Joe A Shaw PA-C - 9/13/2008

Question
QUESTION: May 17, I received force trauma injury to my right foot as the result of an attack. A 160 lb or so man took a running leap at me, landing directly ontop of my foot when my leg was resting extended.
The ER doctor said there was no fracture, and only an MRI could positively verify the extent and type of injury, but I did not get one done.
I had severe swelling lasting abotu 2 weeks, constant horrible stabbing pain for many days, bruising extending from the ankle to the toes, and complete immobility.
The foot couldn't bear any pressure for several weeks.
I have had quite a few "sprained" ankles before, I've even had foot fractures before, and this was certainly NOT the same.
Fast forward 4 months later.
I have lost range of motion in that foot. After sleeping or extended resting the foot is stiff and very painful causing limping. The toe next to the pinky toe has curled under (claw toe?) and it twitches uncontrollably sometimes. Lately, I've had sudden and very severe contractions of at the sole of my feet. It pulls all my toes (except the big toe) under, cramping and contorting my feet so bad I can't help but scream! This usually happens when the foots resting. These contractions are HORRID!
What sort of injury could cause this?
What can be done to relieve all my symptoms?
Could this injury require surgery?
Could the problems go away on their own eventually?
Home care ideas?
thank you much!


ANSWER: Amanda,
You need to be eval by an ortho or a physiatrist(Fizz-i-ah-trist)..preferably one who specializes in feet and ankle problems. MRIs help w diagnosing tendon,muscle and ligament tears and you probably should have gotten one or seen a specialist way back when.
You might have had compartment syndrome which is swelling w/i a confined space and the swelling causes pressure and damage to the nerves that pass through this area.
You also may now be diagnosed w RSD or complex regional pain syndrome..google these terms.. too much to discuss here.
I would do warm epsom salt foot/ankle baths with range of motion exercises to the foot and ankle 3 x day until you can see a specialists

---------- FOLLOW-UP ----------

QUESTION: Do you have any suggestions for at-home foot exercises? The loss of immobility is primarily with the ankle bending inwards...I have been doing rolling exercises (pulling foot up rolling inward with it in circular motion). Is that sufficient?
Also, the swelling subsided 4 or 5 weeks after the injury, it's no longer an issue. I wore a tight stretchy ankle/foot support for abotu 6 weeks. It was so tight that I had to remove it at nights and sometimes during the day too. I no longer wear it, should I consider wearing it again? Thank you for your last response, I appreciate the info. I just read about compartment syndrome. I've yet to read up on RSD, but now I will.

Answer
Yes on exercises turn inward hold for a few secs outward hold etc..x 5-10x then bend foot up like letting off of gas and hold then push down and hold etc then roll ankle etc..
would not wear any constricting pullover wraps. If ankle is weak and giving away try stirrup ankle brace $20-30, but gradually wean off over several wks.
also would massage in biofreeze or ortho gel 3 x day

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