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Monday, April 1, 2013

Turf Toe Injury with Cast Immobilization: Email Advice

Hi Dr. Blake--I wanted to give you an unfortunate update with my foot jog your memory, I mailed you an MRI weeks back, and you indicated that you saw a plantar plate tear at the right big toe. My ortho. agreed, and he told me that a few weeks in the air cast boot would be plenty to heal it completely--he acted as if this was a very minor injury, and that I should be healed in no time. I have a follow-up with him in 2 weeks, but I wanted to share my not-so-much progress with you....

It has been 8 weeks since I started wearing the air cast boot. I am not working out or doing anything beyond walking in a parking lot, from my car to work, etc.  I do have to admit that when I am at home, I take off the boot to breathe a little and walk around (minimally) -- I make sure not to bend my toe or anything.... Anyway, I feel no progress. My foot is still swollen to the point that my shoes no longer fit the foot (I only put a shoe on to make sure that I was not imagining the swelling). The swelling appears to make my foot wide--I think what swells is the arch area, esp. underneath it. The swelling occurs both in and out of the boot, with walking and without walking. I also still have pain at the top of the big toe, and around the ball of my foot and arch. O, and when I elevate my foot, my big toe sometimes twitches uncontrollably. 

Considering that 8 weeks was the top of the healing timeline--do you think that there is an additional problem here? I am saddened to not feel any progress and REALLY scared. Why the swelling at this stage, and why the same type of pain? If you remember, you ruled out the possibility of sesamoid fracture when you looked at the MRI I mailed--my ortho agreed. The podiatrist, however, still is diagnosing me with sesamoiditis and a possible sesamoid fracture.

I am attaching a picture of my swollen foot--I am so embarrassed to be sharing this with you, but I feel that I have no choice but to do so. The right foot is the swollen one--it may be difficult to tell, but its much wider than the left, and much more red in color. I can't believe I mustered the courage to attach this awful pic, but...I am assuming you see worse. The pic doesn't do the swelling justice, but trust me, my foot does not fit in a shoe that I could fit into with absolutely no problem in December.

Does my non-progress concern you? Like I said, I am seeing my ortho in a couple of weeks, but also wanted to get your thoughts on all this. 

Again, thank you so very much for your help, always. 


     Thanks for sharing. I am sorry you are struggling so. 

     Most likely, the immobilization and velcro straps from the boot are not allowing the blood to return easily into your circulation. This will make you hold swelling and it is a common part of immobilization. It is important to begin to ice the foot for 10 minutes 2 times daily and do contrast baths (see blog) each evening. Every chance you get have the boot off and massage the calf where the velcro straps are.

     Whether you are in the boot or out of the boot, elevate your foot somewhat off the ground (even inches can help). Keep your knee slightly bent to avoid irritating the sciatic nerve. You have to work hard on creating a pain free environment. I am assuming that your foot does not hurt in the boot. Since you are at 2 months with all this swelling, physical therapy will be in order once the doc says you are ready.

    Maybe they can get you out of the boot now and into a flat post op shoe for the swelling. That would work really well. The twitching is your nervous system not liking something. Perhaps it is the boot and the torque on your spine. Perhaps the swelling in your foot is compressing the nerves from within. It is good you had the MRI so you can have a comparison if another is needed in the next 1-3 months. Try to massage your foot daily, without eliciting the pain response, to reduce the swelling and get some biofeedback to the tissues that the area is okay. I hope this helps you some. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.