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How to Decide if That Foot Pain is a Fracture

When trying to assess your new foot pain, it’s important to keep note of even the most minor injuries as they can become something more if not protected appropriately.

Whether you dropped a jar on your foot or got stepped on in a game of soccer, don’t dismiss the pain. Sometimes the pain can come on slowly over time; it’s important to know when to get an evaluation.


Direct Impact Injuries and Contusions

In most cases, an appropriate measure for the first couple of days is to assess if the injury is too painful to continue activities. If mild, walk or play through the pain temporarily. However, if you continue to feel pain that is either staying the same or getting worse, you may have developed a bone bruise, or contusion of the foot. This means there is enough injury to the bone without fracture to compromise the integrity of the bone. Your body responds with pain to try and avoid using this area of your foot. The most common place where we see these happen is the metatarsals (pictured here). If these smaller bones are bruised to the point where the integrity is challenged, the continuation of playing or walking can make it prone to a delayed injury or even a delayed fracture.

Make sure to be mindful that the pain is rapidly improving over time. If the injury is not improving as it should, you may find yourself requiring oral medications such as Tylenol or anti-inflammatories to get through the day. It’s at that point where it’s worthwhile to get an evaluation so you don’t sustain an injury that could have been properly prevented.

Stress Fractures

Stress fractures or stress reactions are injuries typically found on the top of the foot in the metatarsal area (shown above). While they can occur in almost any bone, these are the most common. These seemingly trivial injuries can occur over time by simply running on a new trail or through new repetitive movements. This change in activity triggers stress and that repetition can further cause additional stress fracture scenarios. The most common areas we see these fractures are the second through fourth (see image to the right) metatarsal. The first metatarsal is too big and too strong to sustain one of these injuries. If you are not seeing improvement over a few days, or weeks’ time, then an evaluation is highly recommended. In these cases, x-rays are important to make sure that a fracture is not developing.  If the bone has been injured enough, then proper equipment is required to help in the healing process. Whether that equipment be a sandal or a shoe adjustment, it is appropriate to make sure they minimize and improve the state of your forefoot before you are ready to get back to activity. The proper equipment is important. A boot may be required instead of a sandal. This is dependent on the individual’s radiographs and the patient’s history. In addition, how long you must wear the device and how much activity during a day are important variables to ask when being evaluated. Ideally, you want to see 1-2 weeks of no pain before you start to ramp up the activities again while being off pain medication completely. Dr. Miller will give you explicit advice how make these injuries better.


Twisting and Midfoot Sprains

What is a foot sprain? Just like an ankle sprain, the ligaments that connect bones in your foot can be injured. When those connections are partially injured or ruptured, a foot sprain can be a significant injury.  How do you know if your foot is sprained? Many times, we see injuries where the foot will have an awkward landing underneath your ankle. These injuries can be painful enough making it difficult to walk or a moderate pain that simply won’t go away. When that happens, certain ligaments in the middle of your foot (Lisfranc ligament, see image to the left) can get injured, which sometimes require surgery to treat or immobilization. These injuries are characterized by pain on the top of the foot just closer to the ankle than the metatarsals. Sometimes these injuries may also seem trivial if you land the incorrect way, either with your foot falling underneath, or an axial twist of the foot. Both scenarios can result with pain in the middle of your foot. These injuries cause pain on the top of the foot in the middle of the arch. (Black arrow) They also necessitate a prompt evaluation with Dr. Miller to know the severity of the injury and appropriate treatment. Often times they do not get better on their own no matter the grade or level of injury unless immobilized with a boot.

Why are evaluations important?

A proper orthopaedic evaluation consists of a hands-on thorough exam, appropriate x-rays taken with good technique, and possibly advanced imaging studies obtained promptly. At Beacon, we have the capability of obtaining rapid imaging studies and we take pride in offering prompt evaluations. Carefully evaluating these injuries are always important because you want to avoid making an injury worse and be able to recover as fast as possible. Neglecting the injury will often delay recovery. For example, a stress fracture may become a complete fracture. They can move, displace, and require surgery or heal very slowly because of continued use. Without an evaluation, it is very difficult to know if you need surgery or if it’s amenable to boot type non-surgical therapy without really being seen. It’s important not to hold off and come in sooner rather than later because these injuries often necessitate several weeks off. Midfoot sprains, or Lisfranc injury, can be very serious if not evaluated within reasonable time. Often if a midfoot sprain is severe and left untreated, the foot can collapse, change shape, and arthritis eventually ensues with chronic pain.

Do you have nagging foot pain?

Don’t wait, get an evaluation today! Dr. Miller is available at several locations around the Cincinnati area with Beacon Orthopaedics. Contact us today for more information! Click here to learn more and schedule an appointment with Dr. Miller for foot and ankle injuries.