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Foot sprain and fracture- should I insist on MRI?

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  • Foot sprain and fracture- should I insist on MRI?

    My mom's dog tried to attack my cat. I went running after her trying to catch her, and slipped on the wet grass. One foot went out from under me, my other foot landed curled underneath me. The top of my foot took the impact. It was excruciating on impact- felt like I tore every ligament in the top of the foot. I could not get up and my mind was screaming at me to go rescue the cat. Cat ran underneath the car and the wretched dog was trying to crawl after him. The car probably saved my cats life.

    This was on Friday. The pain has been severe. I tried ibuprofen and Tylenol but it throbbed all night long. Then i tried codeine acetaminophen and that was even worse. Codeine and i do not get along and it makes me super depressed and miserable. I was on it for my wisdom teeth removal and let's just say this was a repeat of that experience. It makes me feel suicidal. I wasn't sure the depression i had after the wisdom removal was from the drug but now i know I'm not taking that again!

    Finally decided on Tramadol and that is slightly better pain wise but it is still throbbing, just not as bad. I'm using diclofenac gel as well, because tramadol is not an NSAID and i need to reduce the inflammation.

    I'm eyeing the hydrocodone acetaminophen, but i hate painkillers and I don't want a repeat of the codeine experience.

    ​​​​​​X rays showed a 3rd metatarsal fracture. The doctor said it will heal in 4 weeks and all i need is Ibuprofen and Tylenol. Well, that would be fine, if i could actually get some sleep with the constant throbbing pain. The tramadol is just enough that i can get a couple hours of sleep, but I'm still waking up due to pain.

    I asked about an MRI. I was concerned about whether the fracture is located near a ligament attachment point. The doctor said this isn't a surgical case, and if i stretched the ligaments, they should all pop back into place... Just come back in 4 weeks for another x ray.

    The strange thing is the 3rd metatarsal is not where the severe throbbing pain is. There is severe swelling by the 3rd,4th,and 5th metatarsal, and that entire area is sore, but not bad.

    It's the first metatarsal (below the big toe) that is having sharp pain in both joints. It feels like that is where the throbbing pain is coming from. Do you think i should get a second opinion? Or just give it a week to see if the swelling goes down? If you had asked me before the x rays i would have bet money that it was the 1st metatarsal that I had fractured, given the pain and bruising.

    If those ligaments are torn won't that take months to heal?

    And now i have to decide what I'm going to do with the horses while I'm laid up.



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  • #2
    Based on my recent experience I would say give it a week to 10 days and if the pain hasn’t decreased, get another xray.

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    • #3
      Regardless of the ultimate diagnosis you’ll need to rest it let the seeking go down. I’d give it some time. And stay off it. Did you get a cam boot and/or crutches?

      Comment


      • #4
        You will feel much better with a boot cast. Especially for the first couple of weeks. Fractures hurt like hell if they aren't immobilized.

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        • #5
          Hey I broke the 5th metatarsal on my left foot and I had an air cast from previous fractures. It was recommended to wear that. Plus crutches in the beginning. No weight bearing first week. The boot with air stabilizes your foot/ankle and there is less pain. I found Aleve/Naproxen worked for me for the pain/inflammation. I went back for re x-ray 3 times. I had the walking cast on for 3 months!!!! Near the end I only wore it outside for stability. Didn't wear it to sleep and less in the house as well. This has been my 3rd fracture in a little over two years.

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          • Original Poster

            #6
            They gave me a walking boot, but I can't stand the pressure of the straps, nor can I walk on it. I tried putting weight on it today and even on the hydrocodone I couldn't place my foot fully on the ground... Not happening. The hydrocodone finally gave me a couple good hours of sleep. Even with tramadol I was having pain and it is very difficult to find a comfortable position to sleep.

            It is still swollen and throbbing. Today is day 4 since the accident. I called them back and requested a prescription for pain medication (running out of leftover meds from my wisdom tooth removal). I also asked them for a appointment this week. And asked about an MRI. Somehow I doubt they will get back to me. I do have an appointment with the physician assistant on Thursday, but that isn't a doctor.
            ​​​​​​
            They had the intern do all the diagnosing on my original appointment. The doctor came in for a few minutes but I don't know if he even looked at the x rays. He did a short exam and sent me on my way.

            I'm thinking of going to my primary doctor instead as she was really good when I had wrist pain. Or I could get a copy of my file and go to the orthopedic institute for a second opinion.

            I dug out the horse medicine kit and put a cotton bandage on it and vet wrapped over that rather loosely. I don't want too much pressure on it, but I do want to stabilize the joint so I'm not bending it when I'm hopping on crutches. It's incredibly hard to get comfortable. I tried propping it on pillows, laying flat, laying sideways, holding it off the bed. Nothing helps. Throb, throb, throb.

            Comment


            • #7
              Yeah if you are non weight bearing its time to get deeper diagnostics
              "You can't really debate with someone who has a prescient invisible friend"
              carolprudm

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              • #8
                I assume you are icing and elevating the foot as much as possible? If you are still unable to walk on it, definitely head to the doctor. Anti-inflammatory will be better than pure pain relief. If those heavy duty ones aren't cutting it, you have a bigger problem.
                Proud member of the "Don't rush to kill wildlife" clique!

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                • #9
                  With something as important as your foot, I would definitely go to a good doc and get an MRI. Years ago I broke my foot with pain no where near what you are describing. Crutches for weeks and then walking boot. After whatever the time period that all should have been healed and I was still having pain, my doc dismissed my concern.

                  I spoke w a PT friend to find out who was the best in town and went to that doc who PROMPTLY said I needed an MRI which found a split TENDON. I was able to avoid surgery and spent a year being very careful and it healed.

                  You owe yourself to get the best care from the best doc. It's depressing enough being on crutches. Please keep us posted ok?

                  Comment


                  • #10
                    Reach out to your primary care and any other doc that you can think of! And don’t be afraid of being a Giant PIA!!! Or go to the ER! I’m so sorry that you are in so much pain!!!

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                    • #11
                      I would make an appointment with an ortho, stat! I am also big on being your own advocate when it comes to your health - you know yourself best.

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                      • #12
                        I've been through ankle hell and back...then redid the trip.

                        Stay off your foot and elevate it. Keep it immobilized and figure out how to make the boot tolerable. It is your best friend.

                        Find a GOOD ankle doctor. Don't screw around with your GP or the ER (unless for pain management). ER will just tell you to see an ortho. If you have a good doc, a MRI is superfluous. MRIs are not the end all, be all. Sometimes stuff doesn't show up on them. You obviously have a big problem.

                        When you call to make an appointment, tell them you are non-weight bearing and in a world of hurt. You need help NOW, not in a month.

                        .https://tcomn.com/wp-content/uploads...th-America.pdf is a good place to start for an ankle doc. If you are within a couple hours of one of these guys, or can find someone who trained with one of them, go there first. It does make a difference.

                        HealthBoards has a foot and ankle section and is a good place to find a competent ortho. Looks like you have to waIde through things now. Beware, the mods there are not the COTH mods; they follow the rules ruthlessly, IME
                        Visit my Spoonflower shop

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                        • Original Poster

                          #13
                          I went in for a second opinion today. They have me in an aircast and referred me for an MRI. Possible Lisfranc injury. The cast is more comfortable than I thought. The pain was better but now I'm having tingling in my toes, unrelated to the cast. They do not give scripts for pain medication. This is why i try to stockpile pain medication. In order to get any pain medication i would have to see a specialist in pain management. But i should have enough provided i don't need surgery.

                          Comment

                          • Original Poster

                            #14
                            Well I finally got the MRI done. I'm really getting aggravated with my doctor's office. I have called multiple times, talked to several different people. I was trying to get the prior authorization from the insurance. They told me to expect a call back. I never received one... The MRI order form was not clear as to whether I needed contrast or not. I went down to the MRI office, planning to pay cash. They did have the authorization and we got the MRI done without contrast.

                            I will be really upset if I needed contrast and they failed to mention it... I don't want to pay for a 2nd one. I looked over the images. They looked super blurry, so I don't know what to think. I do suspect I have fractured my navicular bone, but I'm not an expert at reading these things... now waiting on the official report. I sent my doctor's office another message, but doubt I will hear back for a couple days. This is trying my patience and being in severe pain doesn't help.

                            Comment


                            • #15
                              What an ordeal just to get needed medical attention. I hope it turns out in your favor.

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                              • #16
                                Originally posted by 4horses View Post
                                I will be really upset if I needed contrast and they failed to mention it... I don't want to pay for a 2nd one.
                                Don't know about the payment side of MRI with and without contrast but the typical procedure is 2 scans... without contrast, injecting the dye and then a re-scan with contrast.

                                If you have decreed kidney function, contrast is a discussion with your Dr. I can't have contrast MRIs any longer.
                                When you start to observe, you become more effective... your movements soften, you see more, you are more available to becoming a team member. Be an Observer first, a Handler second.

                                Comment

                                • Original Poster

                                  #17
                                  The ligaments are intact. It's a soft tissue contusion and bone bruise.

                                  Comment


                                  • #18
                                    Originally posted by 4horses View Post
                                    The ligaments are intact. It's a soft tissue contusion and bone bruise.
                                    last foot doc I saw said fully two years to heal from a crush injury. Mine will be one year from stompage Feb 18. It's much better now, but it took 8 months before I would call it unconcerning. Healing thoughts to you!!!!
                                    "You can't really debate with someone who has a prescient invisible friend"
                                    carolprudm

                                    Comment


                                    • #19
                                      4horses What's your pain level and are you on crutches?

                                      Comment

                                      • Original Poster

                                        #20
                                        I'm still non weight bearing. The minute i put my foot on the ground, i get shooting pain across the bottom up into my toes. It almost feels like nerve pain. A sharp burning pain. The top is very bruised and swollen, but not as painful as the bottom. Pain on weight bearing is about a 9.5 out of 10. Pain when not weight bearing is down to a 5 without medication, more like a 3 with Advil/Tylenol. Still have a ways to go with healing.



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