Question
Dear Dr. Katz,

I twisted my foot on October 17, exactly three weeks ago. The injury occurred while out of the country on a boat. My flip flop slipped and my foot hyperextended (straight down), which caused immediate excruciating pain, substantial swelling and moderate bruising. The locus of the pain was over the metatarsals (spread between third and fifth maybe) with no pain in the ankle (and relatively good mobility).

Because I was on a boat and out of the country, I stayed off it as best I could and kept it snuggly wrapped in an ace bandage to immobilize and keep swelling down.

I've only just been to a doctor this week, two and a half weeks later (because I am unemployed and self-pay). The xray shows no fracture and swelling and bruising are minimal, yet the foot is still painful in the same localized area.

I was prescribed a CAM boot (which is hell on the hips, by the way - I don't know why docs don't tell you that), icing and elevation. The docs also want me to come back in two weeks for another x ray. I am walking on the boot with no problem. My foot goes back and forth but I don't detect rapid improvement.

First, is it puzzling that my foot would still be painful after three weeks? I am very athletic and play drums so have strong muscles in my feet. Everyone seems to think a sprain would have improved more than it has.

Second, is it possible that there might be a stress fracture? In which case, could that be detected in an xray?

Third, if the likelihood of a stress fracture is very low and the xray showed no abnormality, then for what reason would I need to go in for a second xray? Given the expense, I'd like to avoid unnecessary procedures.

Many thanks for your thoughts.

Lenora

Answer
Hi Lenora,

A foot or ankle sprain can take months to heal.  it is possible that you have a stress fracture and it may not show early especially if the foot was not immobilized.  The CAM walkers require that you have a shoe on the other foot with the same heel height to avoid hip and back pain.

Taking another x-ray may reveal a stress fracture.  Also there could be some tear of a tendon or ligament or even a hidden fracture.  If you continue to have pain you may need an MRI.

Look into doing some physical therapy for more rapid healing.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com
www.cryosurgerypodiatrist.com



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