Foot Injuries: When to Seek Medical Attention After a Fall

Hello, Dr. Shih. I slipped and fell in the bathroom on May 15, and I have a bruise on the left side of my foot?

On May 15, I accidentally slipped and fell.
It seems that my left foot slid forward first, and my right foot was not stable, causing me to land on my buttocks.
After landing, I am unsure whether my left foot was injured at that moment or if it was my left foot that hit the wall, as the bathroom is not very large.
When I fell, my foot might have hit something (I cannot confirm).
When I got up, my left foot was very painful, and it hurt to put weight on it.
The pain lasted for about half a day, and by the next morning (May 16), it was no longer painful except when stepping on the floor.
However, by May 17, the pain when stepping on the floor decreased further, concentrating on a specific point (Image 1, the pressure point under the big toe).
Currently, the pain is almost entirely at this point with little change.
From the appearance, there is no swelling, only a bruise (Image 2), and it seems to subside somewhat after standing for a while.
The pain point is triggered only when I apply pressure on my heel; if I apply pressure forward, it does not trigger pain, and simply standing still does not cause pain either.
Previously, I had a bone fracture at the junction of my big toe and index toe due to a fall, which required a cast for nearly four months before it healed and was removed.
At that time, I had swelling at the fracture site, but this time there is no swelling, only bruising.
I wonder if I should just rest and let it heal slowly or if I need to go to the hospital for evaluation and treatment.

Mr. Chen, 30~39 year old female. Ask Date: 2023/05/20

Dr. Shi Guozheng reply Orthopedics

If it is just a bruise without a fracture, applying ice for the first two to three days followed by heat therapy usually allows the bruising to resolve in about two to four weeks.
If there is a suspicion of a fracture, an X-ray examination is necessary.

Reply Date: 2023/05/20

More Info

When it comes to foot injuries, especially after a fall, it is crucial to understand the signs that indicate when medical attention is necessary. Based on your description, it seems that you experienced a fall that resulted in pain localized primarily around the area where your big toe meets your second toe. While the pain has decreased over time and there is no significant swelling, there are still important factors to consider.

First, let's discuss the nature of your injury. The fact that you experienced immediate pain after the fall, followed by a gradual decrease in pain, is a positive sign. However, the presence of bruising and localized pain can indicate a soft tissue injury, such as a sprain or a contusion, or even a possible fracture, especially given your history of a previous bone injury in the same area. The absence of swelling is also noteworthy, as swelling often accompanies fractures or more severe injuries.

In general, if you experience any of the following symptoms, it is advisable to seek medical attention:
1. Severe Pain: If the pain is intense and does not improve with rest or over-the-counter pain medications, it could indicate a more serious injury.

2. Inability to Bear Weight: If you find it difficult or impossible to put weight on the affected foot, this could suggest a fracture or significant ligament damage.

3. Persistent Swelling or Bruising: While you mentioned that there is no significant swelling, if you notice any increase in swelling or if bruising spreads, it may warrant further evaluation.

4. Deformity: Any visible deformity in the foot or toes should be assessed by a healthcare professional.

5. Numbness or Tingling: If you experience numbness, tingling, or a feeling of weakness in the foot, this could indicate nerve involvement.

6. Pain that Worsens Over Time: If the pain does not improve or worsens after a few days, it is essential to consult a physician.

Given your previous history of a bone injury in the same area, it may be prudent to err on the side of caution. Even if the pain has decreased, the fact that it is still localized and you have a history of a fracture raises the possibility of a new injury that may not be immediately apparent.

In terms of treatment, if you decide to manage the injury at home, consider the following:
- Rest: Avoid putting weight on the injured foot as much as possible to allow healing.

- Ice: Apply ice to the affected area for 15-20 minutes every hour to reduce pain and swelling.

- Compression: Use an elastic bandage to wrap the foot, but ensure it is not too tight to avoid cutting off circulation.

- Elevation: Keep the foot elevated above heart level to help reduce swelling.

If after a few days there is no improvement or if the pain persists, it would be wise to visit a healthcare provider for an evaluation. They may recommend imaging studies, such as X-rays, to rule out any fractures or other injuries that may not be visible through physical examination alone.

In conclusion, while your symptoms may suggest a minor injury that could heal with conservative management, your previous injury history and the nature of your current symptoms warrant careful monitoring. If there is any doubt or if symptoms worsen, seeking medical attention is the best course of action to ensure proper diagnosis and treatment.

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