Do I go back for another x-ray?

[BigMama1]

Will try to make this long story short. 17 days ago my friends horse startled in the crossties, jumped up and came straight down on the outside half of my left foot. Hard. I was wearing boots, but soft fabric snow boots, not leather barn boots. There’s an important safety reminder in there!

Within 20 minutes the pain went to numbness and there was a good bit of swelling and bruising. My pinky toe was completely black with some lovely bright purple indents from the horse’s winter studs. I have previously broken that little toe (from a horse jumping on it of course) and figured it was broken again, also figured there was nothing they could do about it. But the pain and bruising was enough that I worried my actual foot was broken so I was a mature adult and went to the ER a few hours after the injury.

Dr said X-rays clean; nothing broken, not even the toe. Only thing he could see was a healed foot fracture. I can only assume that when I thought I broke my toe 30 years ago I actually broke my foot. Said no need for a boot or even crutches and sent us on our way.

More than two weeks later the bruising is 75% gone and the swelling is reduced. Top of foot where winter studs landed still very tender. Little toe extremely tender to the point where I still can’t stand the weight of bedsheets or even a sock on it. Cannot move my pinky toe and the one next to it at all. Just get no response even though I feel like I’m moving the right muscles, and if I try harder I just get sharp pain where the toe meets my foot, plus tingling / pins and needles in my other toe. Still have a significant limp unless I am barefoot. Can’t wear shoes other that Uggs in bare feet and even that is uncomfortable.

Does this sound normal after 17 days for just a bad bruise with no fracture? Am I just being impatient and need to wait it out or should I go back for another xray to see if they missed something amid all the swelling the first time?

The big issue (aside from the annoyance and inconvenience) is that I haven’t been able to ride!

[Where_sMyWhite]

I would. Or maybe start with PCP and talk about all the symptoms as you might need other/different diagnostics than x-rays.

[BigMama1]

@Where'sMyWhite

I would. Or maybe start with PCP and talk about all the symptoms as you might need other/different diagnostics than x-rays.

Problem is I live in Canada and there’s a limit to what my PCP can do. She would likely order an X-ray and get a report back but after that then what? If there is a fracture and I need to see an ortho it would take weeks, if not months to get an appointment. Whereas if I go through the ER again I would get referred to an ortho at the hospital immediately. I love our universal health system for many reasons but the delay for specialists in non-urgent cases can be frustrating

[hoopoe]

I would wonder if what you are experiencing is more nerve related pain than bone related.

I sympathize with you on the constraints of the health care system. YOu know how the system works best for you

You might be able to have your films from the ER requested review by foot ortho to get another opinion on fracture? Though it sounds like the doctor had good films if they could distinguish an old healed fracture

Otherwise it sounds like what you really need is an exam by an ortho with a foot specialty and possibly an MRI. Crushed or partially torn tendons are really painful, I dealt with that last year and was unable to open my car door with my hand for almost 2 months

Call your PCP? use of topical NSAIDS?

Probably more healing time is the answer, if it is nerve pain that can be quite a while

[Where_sMyWhite]

@BigMama1 I was thinking along the same lines as hoopoe, maybe neuro vs ortho. x-rays are good for bones but if there is a nerve or other soft tissue, maybe CAT or MRI might be more in order as they show different things from each other and different from an x-ray.

If you went the ER route again, could you talk with them about all the different symptoms you’re having and would they refer you to a more appropriate specialist (if that is indeed the case).

[BigMama1]

@Where'sMyWhite

@BigMama1 I was thinking along the same lines as hoopoe, maybe neuro vs ortho. x-rays are good for bones but if there is a nerve or other soft tissue, maybe CAT or MRI might be more in order as they show different things from each other and different from an x-ray.

If you went the ER route again, could you talk with them about all the different symptoms you’re having and would they refer you to a more appropriate specialist (if that is indeed the case).

Yes, I think that would be the best route and they would refer me for follow up to whatever is most appropriate. Assuming they think something is actually wrong anyway. I hate to clog up the ER with something clearly not an emergency, especially if they just tell me to go home and be patient lol. That’s why I’m on the fence whether my symptoms fall into the range of “normal” or not. If I’m barefoot and can stay quietly at home for a couple of days it feels pretty good. As soon as I do grocery shopping or even walking around at work, it flares up. Keeping the toe taped the one next to it and/or wrapping the entire foot (with vet wrap lol) doesn’t seem to reduce the pain of contact

[hoopoe]

that is a lot of damage to heal from. There are cells in there scavenging all that damaged tissue. It is going to take a lot of time for that infammation to go away. I got trod on once , over the instep and it took easily 2 years for the superficial numbness to go away. for about 4 or 5 years the area would not redden up when I took a hot shower or bath, always stayed blanch white. It was not painful or restricting, the way this is for you however.I understand how you feel about going to ER. Here I could self refer . Last fall I did and was at the ortho within 1 week and had an MRI 2 days later and an in office consult the following week.

I would contact PCP and really make a case for the pain and restriction of activity this is causing. If anything you should be in appropriate PT to make sure, if it is tendon damage, that you get back in proper form in a safe and correct manner.

[HungarianHippo]

OWIE! Honestly, given how much soft tissue damage you clearly had, my non-medical opinion is that it’s just going to take time. Unless your gut is saying this seems like a surgical case, not much else you can do but RICE. Speaking of, have you been RICE-ing religiously? If not, get on that. I’d probably have the PCP do Xrays and get the referral, and in the meantime do self-care while you wait for that appointment. Might as well experiment with splinting the two little toes to see if you can get some relief. (On the other hand, If those little toes are cold to the touch, I’d go to the emergency room rather than mess around with circulatory concerns.)

You can always cancel the specialist if it’s clearly healing as that appointment nears.

[BigMama1]

@HungarianHippo

OWIE! Honestly, given how much soft tissue damage you clearly had, my non-medical opinion is that it’s just going to take time. Unless your gut is saying this seems like a surgical case, not much else you can do but RICE. Speaking of, have you been RICE-ing religiously? If not, get on that. I’d probably have the PCP do Xrays and get the referral, and in the meantime do self-care while you wait for that appointment. Might as well experiment with splinting the two little toes to see if you can get some relief. (On the other hand, If those little toes are cold to the touch, I’d go to the emergency room rather than mess around with circulatory concerns.)

You can always cancel the specialist if it’s clearly healing as that appointment nears.

Rest - not exactly, except for the first 24 hours when I could t walk on it at all. Because the ER dr was so blase about it, recommended against a boot, didn’t suggest crutches or any treatment other than Tylenol, I assumed weight bearing as tolerated wouldn’t delay healing. I’ve been going to work (desk job mostly), Christmas shopping, running errands and trying to get to the barn a couple days a week to at least groom my horse and tack up for my trainer, since I can’t ride. I have drastically reduced activity and limit errands, etc to only the most essential, but that still adds up to a fair bit of walking around during the day.

Ice - for the first day I couldn’t even stand the pressure of a bag of frozen peas on it. Did ice throughout the second day but didn’t think it did much good more than 24 hours after injury, so no to that one.

Compression - it’s only been the last couple of days that I could tolerate having something wrapped around it so have been experimenting with taping the two toes together bs taping the entire foot for support / a layer of protection. Honestly neither approach seems to make much difference.

Elevation - definitely did as much of this as possible the first 2 or 3 days and when I’m home I’ve been trying to keep it up as much as possible still. It really doesn’t throb or ache much now unless I touch it or move it the wrong way.

My gut tells me this is more than a simple bruise but I really do waver back and forth on whether it just needs time or medical intervention. I do have a great physio but haven’t been to see him yet because I can’t even imagine letting someone tough it / move it around.

[4horses]

I would get a second opinion. It sounds like nerve damage to me, especially the lack of movement. Perhaps not broken but a compressed nerve or soft tissue damage. Honestly I rather deal with a broken bone then soft tissue damage. I pulled a tiny ligament in my foot and it took 2 years to heal. It still swells if i don’t use shoes with arch support.

[Wonders12]

I did some damage to my foot from getting stepped on, and I hate going to the doctor since they’re usually just going to tell me what I already know.

But this would have me back in the ER if PCP isn’t a time appropriate option. When you go in, don’t minimize it. I would emphasize the movement/pain to the touch issues and explain that you’re not able to go about your daily activities, even when you eliminate exercise (riding).

You took the doctor’s advice, but that much pain after 17 days is enough to revisit.

[Ceylon_Star]

Do you have an urgent care clinic or similar out that way? We have one here that is sort of a step between GP and ER. They would be where I would go for something that isn’t healing at a normal rate, and I went there when I got double barrelled in the stomach by a tank lusitano mare a couple years ago vs going to the ER. Ours shares space in a building that has a medical imaging center in it, but not all do. Some still have to send you to the hospital for imaging, but if they find anything they can usually get you in to see the right specialist faster than your PCP can.

[BigMama1]

@Ceylon Star

Do you have an urgent care clinic or similar out that way? We have one here that is sort of a step between GP and ER. They would be where I would go for something that isn’t healing at a normal rate, and I went there when I got double barrelled in the stomach by a tank lusitano mare a couple years ago vs going to the ER. Ours shares space in a building that has a medical imaging center in it, but not all do. Some still have to send you to the hospital for imaging, but if they find anything they can usually get you in to see the right specialist faster than your PCP can.

We don’t have Urgent Care here anymore. Imaging can be done immediately at private clinics though, which is good. I did see a sports medicine dr a few months ago to have my knee injected. Maybe she would be a better place to start than going back to ER? I honestly don’t know

[lwk]

I would get another x-ray. I’ve had several foot fractures and my experience is that they may not show up on x-ray right away. I’m not familiar with the Canadian health system so no help there.

[arabiansrock]

get another xray. asap. IN the meantime go find the stiffest, least flexible pair of shoes you can find than have plenty of room in the toe box for your toe. I had a VERY sore big toe, no redness, no swelling, no accident that I knew of. Coworkers said it was gout. after 3 months went to pcp. he said tendonitis. I said it feels broken. he said tendonitis but to make you happy I will order xray. It was broken in 2 spots. so off to ortho I went who booted me. 6 weeks in boot, then stiff shoes for months after. A year later it still hurts off and on but its mostly better now.

They say they can’t always see a fracture when it is fresh, sometimes they need to see the beginning of the calcification to identify fracture. So now is a perfect time to go back and say It still hurts like crazy please do another xray.

[joiedevie99]

X-rays and ultrasound are super difficult to read in the immediate aftermath of an injury. Most orthos here re-do imaging 5-7 days later after swelling has subsided.

[Simkie]

Agree that a repeat radiographs would be worthwhile. Fractures are often difficult to see right away–it’s not unusual for a film to be “clean” but show a break in a few days.

Good luck, and hope you feel better soon–that looks so painful! :eek:

[Jumpshorsez]

Rad Tech here,

We usually have people return in 7 days if the pain is significantly worse after initial clean films because of swelling. On the other hand, plain film will only show a fracture, not tendon damage. And we do very little for a fractured toe unless it’s messed up beyond belief. So it’s a risk vs benefit of more radiation and another visit for possibly nothing useful in return.

[BigMama1]

@Jumpshorsez

Rad Tech here,

We usually have people return in 7 days if the pain is significantly worse after initial clean films because of swelling. On the other hand, plain film will only show a fracture, not tendon damage. And we do very little for a fractured toe unless it’s messed up beyond belief. So it’s a risk vs benefit of more radiation and another visit for possibly nothing useful in return.

That’s my worry - that I’d be wasting everyone’s time for nothing. And though I definitely have some foot pain and lots of tingling in the foot, the sharp pain is pretty much entirely in the toe. I can bear full weight on the foot if I’m in bare feet, which makes me think the foot is not fractured? But then again when I had the literal tibial plateau fracture I could bear weight too.

If it is nerve and / or soft tissue damage does anyone know if there is treatment? Or is it just a matter of time? I guess what I’m wondering is if I am delaying healing or causing damage by attempting to carry out normal activities to the best of my ability? Or should I be staying off it completely? I had assumed not since the ER doc recommended against a boot and didn’t suggest crutches. I used a cane for the first few days to help with my balance but don’t need that now, as long as I walk slowly without bending or pushing off the foot.

[Barn_Mom]

Best case scenario is that you waste some people’s time and learn that your foot is fine and just needs time. You are worth the time and trouble! Foot pain blows chunks…if it was my foot, I’d go back to the ER if that was the most expedient way to a diagnosis.
I’m not a doc, nor do I play one on TV…based on where the studs hit on the top of your foot, there could be a break…your symptoms sound like some sort of nerve impingement.
I recently had big toe surgery for a giant bone spur and the opposite of a bunion…big toe was trying to be a thumb. The surgery and swelling afterward, brought to light a Morton’s Neuroma that I didn’t know I had. What I’ve learned is that nerve pain is like no other! Like there were tears involved! And any sort of pressure or wrap around my foot brings the feeling of fire and hot pokers…or tingling and numbness.
Go and get your hoof checked out!!! Fingers, toes, eyes and legs crossed for a good result!!!