Question
Greetings doctor! Im a 25 year old male, about 1 month ago I was going down the stairs of my apartment building, I stepped incorrectly with my left foot and it sort of "Rolled" onto the left side.  A large lump appeared on the left TOP portion of the foot, between the ankle and the toes. After several days this lump dissappeared.

However the pain has continued, although it only occurs at certain times and i'll try to explain the symptomology as best as possible.

1. I can bear weight on the foot with no problem.

2. In the morning the foot hurts in that particular area.

3. If I completely extend the foot "toes pointing outwards" I can feel the location of pain, although it isn't overly painful.

4. If I run my fingers over the area and push I can recreate the pain as well, although again the pain has minimized since the initial contact.


 It has now been about a month and a week, I was able to jog again several days ago but about an hour after the jogging the pain gets pretty strong again.  I'd really just like your honest opinion as to whether this will get better or not, whether you believe it is a break... I guess just give me the good news and the bad news.  I am unable to afford going to a doctor currently, so i'd like just the best feedback and how to treat the current situation. Thanks so much

Answer
Hi, Kevin,

So sorry to hear about your situation!  As a physician, I really do need to recommend that you go somewhere for an X-ray and treatment.  Call or ask around, see where it would be less expensive, and try to go somewhere.

From what you're describing, it does sound entirely possible that you have a fracture.  I would need an X-ray to be sure, but the way the injury occurred, the swelling (the "lump" you described) and the type of pain you're describing, especially a month after the injury, makes me think that it's more than a sprain.  You could have torn a tendon, possibly pulled off some bone (which is called an avulsion fracture), but you also could have what is called a Jones fracture.

A Jones fracture describes a break in a certain part of your fifth metatarsal, or the long bone behind your little toe.  That part of the bone doesn't get a lot of blood, so there's a higher risk of what's called a "nonunion," which is when the bone doesn't heal but stays broken.  Sometimes connective tissue holds the pieces close to each other, but that tissue isn't as solid as bone, and the pieces would be able to move, which hurts.  An untreated Jones fracture can lead to chronic pain, which means it would hurt whenever you run, and after a while, even walking could be painful.  An untreated injury can also cause chronic arthritis at a young age, and you're way too young to have pain for the rest of your life!  If the tendon is injured, that could potentially lead to a complete rupture of that tendon, which would require surgery.

Although I know that money can be very tight, I'd strongly recommend that you find a podiatrist or go to an urgent care center or hospital (urgent care is usually cheaper) that will work with you to properly assess and treat your condition in order to try to avoid the complications I have described.  If you're in NYC or can get to Cleveland or Philadelphia, there are also usually clinics at or near the podiatry schools in those areas.  That might be an even cheaper way to go, as you would be seen by students (overseen by doctors) and potentially the doctors themselves.

In the meantime, ice and elevate your foot, try to stay off it as much as possible, and wear shoes with a stiff sole, so your foot doesn't move as much.  The more those pieces of bone (or tendon) move, the lower the chance that they will heal properly.

Best of luck to you, and I hope this helps.

Wishing you health, happiness, and peace,
Dr. Bodart