Two Years of Persistent Foot Swelling After Car Accident: Seeking Solutions

Injured in a car accident, experiencing swelling in the ankle for two years?

Hello, doctor.
I would like to consult about an elderly person whose foot was run over by a wheel.
There were no external injuries, and upon immediate medical attention, the hospital performed an X-ray which indicated a small fracture in the pelvis but no break.
The doctor mentioned that the bone would heal on its own and prescribed medication for peripheral circulation and pain relief, advising to observe at home.
They were instructed to elevate the foot, soak it in warm water, and take the medication.
However, the swelling and pain in the foot have remained unbearable.
It has been two years since the accident.
Throughout this time, both Western and traditional Chinese medicine have been tried, including a visit to National Taiwan University Hospital where another X-ray was taken.
The doctor stated that there was no major issue with the foot but suggested seeking a second opinion if there were still concerns.
Medication was prescribed, and upon returning home, a visit to Changhua Hospital was made.
The doctor there also took an X-ray and noted two small unclear white spots, which could indicate calcification, and prescribed medication.
A visit to a traditional Chinese medicine practitioner followed, who examined the foot and suggested that the bones were misaligned, causing poor circulation, and recommended adjusting the bone position along with medication.

Currently, the swelling in the foot has slightly decreased, but the patient cannot stand for long periods and experiences significant pain while walking (with a sensation of foreign object friction).
Recently, I have observed that there is a noticeable difference in the size of the calf muscles between both legs, raising concerns about continued degeneration and atrophy.
My questions are: Is it true that after two years of foot swelling, there are really no issues? Are the two white spots on the X-ray indicative of calcification, and will they not hinder walking? Which specialists should we consult for further assistance in resolving these concerns? I sincerely request your help.
Thank you for your response!

Niming, 30~39 year old female. Ask Date: 2018/04/12

Dr. Shi Guozheng reply Orthopedics

Foot fractures are often accompanied by swelling, so it is best to engage in foot rehabilitation.
Frequently elevating the foot can help improve blood flow.
If there is no improvement, it may be worth considering whether there are underlying conditions, such as kidney, heart, or liver issues.
The less you move your foot, the worse the condition may become, potentially leading to atrophy.
Therefore, it is advisable to continue rehabilitation and seek treatment from an internist.

Reply Date: 2018/04/12

More Info

It sounds like you are dealing with a complex and frustrating situation regarding persistent foot swelling and pain following a car accident two years ago. Given the history you've provided, it is essential to approach this issue from multiple angles to ensure a comprehensive understanding and treatment plan.

Firstly, the fact that you experienced a small fracture in the pelvis, as indicated by the initial X-ray, could have long-term implications. Even if the fracture was minor and the bone was expected to heal on its own, the surrounding soft tissues, including muscles, ligaments, and tendons, may have sustained damage that is not visible on standard X-rays. This could lead to chronic pain and swelling, as well as potential issues with circulation in the affected area.

The presence of two small white spots on the X-ray, which were suggested to be calcifications, could indicate a few things. Calcifications can occur as a result of previous trauma, and while they may not directly impede movement, they can contribute to discomfort and may be associated with underlying issues such as tendinitis or bursitis. It is crucial to have a specialist evaluate these findings in the context of your ongoing symptoms.

Given that you have already consulted various healthcare providers, including orthopedic and traditional Chinese medicine practitioners, it may be beneficial to seek out a specialist in physical medicine and rehabilitation (PM&R), also known as a physiatrist. These professionals focus on restoring function and alleviating pain through non-surgical means, including physical therapy, medication management, and other modalities. They can conduct a thorough evaluation, possibly including advanced imaging like MRI, to assess soft tissue injuries that may not have been previously identified.

Additionally, it is important to consider the role of rehabilitation in your recovery. Physical therapy can be particularly effective in addressing muscle imbalances, improving circulation, and enhancing overall function. A physical therapist can design a tailored exercise program that focuses on strengthening the muscles around the ankle and foot, improving flexibility, and promoting better circulation. This is especially important given your observation of muscle size differences between your legs, which may indicate atrophy or disuse of the affected limb.

In terms of managing your symptoms, continuing to elevate your foot and applying heat may provide some relief, but it is also essential to incorporate appropriate exercises to promote blood flow and reduce swelling. Compression garments may also be beneficial in managing swelling, especially if you are on your feet for extended periods.

Lastly, if you continue to experience significant pain and swelling despite these interventions, it may be worth exploring other diagnostic avenues, such as nerve conduction studies or vascular assessments, to rule out any underlying issues that could be contributing to your symptoms.

In summary, while the initial assessments may not have indicated severe damage, the ongoing symptoms suggest that there may be more to address. Seeking a comprehensive evaluation from a specialist in physical medicine and rehabilitation, along with a structured rehabilitation program, could be key steps in your recovery process. It is crucial to remain proactive in your healthcare journey and advocate for the necessary evaluations and treatments to improve your quality of life.

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