Persistent Swelling and Pain in Toe: Causes and Treatment Options

The finger cannot bend, and the swelling has not subsided for a long time?

At the beginning of last month, I went to the beach and possibly injured my toe when it hit a reef while getting in and out of the water.
I didn't notice the injury at the time, but after kicking a few times with my fins, I became aware of the pain and found it difficult to exert force.
Later, I discovered that my toe and the top of my foot were bruised and swollen.
The next day, I visited a traditional Chinese medicine practitioner for acupuncture and received herbal poultices.
I also had an X-ray to check for any bone issues, which came back normal.
I have been consistently applying heat and topical medication, and I receive acupuncture treatment once a week.
Additionally, I have been massaging the swollen area (holding it still and gently rotating).
The swollen area feels hard and painful, but even after five weeks, my toe remains swollen and I still cannot exert force or bend it without pain.

Anan, 20~29 year old female. Ask Date: 2020/01/26

Dr. Wu Huixiong reply Family Medicine

It is advisable for you to discuss your condition further with your attending physician.
Wishing you good health!

Reply Date: 2020/01/26

More Info

Persistent swelling and pain in the toe following an injury can be quite concerning, especially when symptoms persist despite initial treatment. Based on your description, it seems that you sustained a soft tissue injury to your toe and possibly the surrounding structures after hitting a rock while at the beach. The fact that you experienced bruising and swelling indicates that there was likely some degree of trauma, possibly involving the ligaments, tendons, or muscles around the toe.

Possible Causes of Persistent Swelling and Pain
1. Soft Tissue Injury: The most common cause of persistent swelling and pain after a toe injury is a soft tissue injury, which includes sprains, strains, or contusions. These injuries can take time to heal, especially if they involve the ligaments or tendons.

2. Contusion: A bruise (contusion) can cause localized swelling and pain. The swelling may persist if the area is not given adequate rest or if there is ongoing irritation.

3. Tendonitis: If the tendons around the toe are inflamed due to overuse or injury, this can lead to pain and swelling. Tendonitis can develop if the toe is used excessively during the healing process.

4. Capsulitis: This is inflammation of the joint capsule, which can occur after trauma. It can lead to pain and swelling in the affected toe.

5. Fracture: Although your X-ray showed no fractures, it's worth noting that some hairline fractures may not be visible on initial imaging. If the pain persists, a follow-up with advanced imaging like an MRI may be warranted to rule out any subtle fractures or soft tissue injuries.

6. Infection: While less likely, if there is an open wound or if the swelling is accompanied by increased redness, warmth, or discharge, an infection could be a concern.

Treatment Options
1. Rest and Elevation: It's crucial to rest the injured toe and elevate it to reduce swelling. Avoid putting weight on it as much as possible.

2. Ice Therapy: Continue applying ice packs to the affected area for 15-20 minutes several times a day to help reduce swelling and pain.

3. Compression: Using a compression bandage can help control swelling. However, ensure that it is not too tight, as this can impede circulation.

4. Physical Therapy: If the swelling and pain persist, consider consulting a physical therapist. They can provide targeted exercises to improve mobility and strength in the toe and surrounding areas.

5. Medication: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and reduce inflammation. However, consult with a healthcare provider before starting any medication.

6. Follow-Up Imaging: If symptoms do not improve, a follow-up with imaging studies such as an MRI may be necessary to evaluate for any soft tissue injuries or other underlying issues.

7. Alternative Therapies: Continue with acupuncture and massage therapy as they can help alleviate pain and promote healing. However, ensure that these treatments are performed by qualified professionals.

8. Surgical Consultation: In rare cases, if there is significant damage to the ligaments or tendons, surgical intervention may be necessary. This would typically be a last resort after conservative measures have been exhausted.

Conclusion
Persistent swelling and pain in the toe after an injury can be frustrating, but with appropriate care and management, most soft tissue injuries will heal over time. It is essential to listen to your body and avoid activities that exacerbate the pain. If you continue to experience symptoms, seeking further evaluation from a healthcare professional is advisable to ensure that no underlying issues are being overlooked.

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