Healthy Foot Blog/Sports Injuries/When Your Doctor Hurts His Foot...

When Your Doctor Hurts His Foot...

Monday, August 30, 2010

Sports injuries are common, and usually will interfere with regular activities, but when Dr Gibson broke his foot playing soccer, it was an opportunity for you to learn more about how he cares for his own.

  • He gives recommendations, but does he follow the same recommendations? 
  • Will the treatment be different as the doctor?

7 Aug 2010 - Dr Gibson Breaks His Foot Playing Soccer (previous blog post)

I really enjoy playing soccer, and have been playing in a Highland Co-ed Adult league for 3 years (only in the summer). This league is designed to let people enjoy soccer and often includes "newbies" (players playing soccer for the first time). It was in this game last Saturday that everything happened.

As a defender, I take it personally when a goal is scored. I had been beat 3 times by this player and decided I wouldn't let it happen again. As he moved with the ball, I reached and took controll of the ball with the right foot, while planting the left. As with many soccer fields in Utah, the surface was uneven and I twisted my foot under (the typical mechanism of an ankle sprain). It hurt, but I rarely ever truly sprain my ankle. I distributed the ball and then hobbled back to my position on the field. This hurt much more than usual and I was unable to run as completely for the last 10 minutes of the game. (Special note: If you hurt your ankle or foot, it is not recommended that you run through the pain as this can make any injury worse.)

As I went home after the game, here is the process I underwent in treating my injury:

  • Limiting activities initially:  Walking caused increased pain, so I wanted to protect it for several hours and see how it recovered.
  • Ice to area:  Ice is designed to reduce swelling and can often decrease pain significantly.  This is a key part of treating any injury.
  • Heat to area:  Ice was helping, but was insufficient to decrease the pain.  Heat (as opposed to ice) increases the blood flow to the area and can help remove "junk" that the body has after an injury.  Alternating hot and cold is usually a great idea, but cold should be final or the foot will swell significantly!
  • Compressive Wrap:  Placing an elastic or ace wrap to the foot and ankle helped support it and decrease the pain. RICE is the best acronym (Rest, Ice, Compression, Elevation).
  • Vibration:  On a soccer field, a football field or by a track, it is easy to test an injury for bone involvement by using a tuning fork and testing the injured area.  When a bone is broken, it usually will hurt more with vibration.  In my case, however, it didn't hurt to vibrate.
  • X-ray:  With the above treatments, and the addition of ibuprofen or other anti-inflammatory, often the pain improves.  Since mine was getting worse over time, I knew it was time for an X-ray.  Taking my own x-ray revealed a broken bone in the foot.
  • Protection in a Cast Boot:   There are multiple options for treating a broken foot, from a ankle brace to a post-op shoe to a cast or boot.  I chose the boot as it provides the protection of a cast but the ease of showering without keeping the foot dry (Besides, it is hard to cast my own foot.)  The boot, however, is to be utilized as a cast, except removal for showers (i.e. I am sleeping in the boot too.)

Other things that can be done include pain medications, but I wanted to see the progress of the healing and didn't want to interfere with the sensations. This is for my learning (and the pain hasn't been that bad).

Continue to watch this blog and I will post the progression of the fracture healing also. 

Big Question: how good a patient I am?

10 Aug 2010 - The First 48 Hours After Injury (previous blog post)

After breaking my foot on Saturday, the area began to progressively swell and the pain seemed to increase. I was able to walk on the foot, but only with significant pain that was getting worse as the hours passed. Shoes were a problem, in fact, they increased the pain (except my Crocs that gave me the necessary room in the area). So what was I expecting (and had happen) during the first 48 hours?

  • Bruising: Bruising may occur immediately, depending on the tissues injured, but often presents over the first several days. This often spreads to the farthest areas of the foot (toes and heel) and may not present where the actually injury is. I have significant bruising to the toes and to the heel, even with the fracture elsewhere in the foot. 
  • Increasing Pain: Pain is the bodies protection mechanism and is designed to reduce activity during healing. Depending on the injury, pain can be caused by bone rubbing on bone or just the swelling pressure to the area (and associated nerves). In my case, the pain increased over the first day, but improved some with the boot (since it stabilized the ankle and the foot). Night was the worst and sleeping wasn't as good as it could have been had I taken something for pain. 
  • Swelling: The primary process the body utilizes to start the healing process is through swelling the area (edema). This serves two purposes: 1) Splinting of the area to protect the injured area. 2) Cause migration of healing cells to the area of injury. In my case, the swelling was significant right to the area of fracture, and got worse through the next 2 days even with ice. Maintaining it in the walking boot with a compressive wrap (ace wrap) in place helped significantly.

The first 48 hours will be the hardest, but after that time, the pain will be more manageable, the swelling will be easier to control and the walking will be better. I know that now by personal experience.

28 Aug 2010 - Pain Gone But Staying In Boot To Speed Healing (previous blog post)

I fractured my foot just over 3 weeks ago and had significant pain initially, but the pain has steadily improved. I now walk without pain in the walking boot, can stand for prolonged periods without noticing the foot (most the time) and can even stand or (carefully) walk on the foot without the boot and not have pain. Any pressure or touching of the fractured area produces no pain either. Since vibration to the bone has never hurt in this particular fracture, it still doesn't. Does that mean I am healed and can stop wearing the boot?

The easy answer to this question is No. Bone healing is a process that takes anywhere from 6 - 8 weeks to heal. Poor circulation, smoking (which decreases blood flow to the feet), removing the cast or boot (which allows movement of the fractured area) and poor nutrition can all slow this healing process. Kids also usually heal more quickly than adults. Therefore, the area should be protected during this healing process for at least 4 weeks, but usually 6 - 8 weeks.

How Do I Know When The Boot Can Be Removed?

Often people will remove the boot because it doesn't hurt anymore. This will usually happen around 3-4 weeks and indicates that the bone is more stable. On some fractures removal is not a problem at this time, but could slow down the healing, or worse allow the area to be refractured before it is healed.

Since I currently have a fractured 5th metatarsal, I will explain what I am doing. I want to stay active and return to running as quickly as possible. I don't want to limit my activities any more than I need to (even in the boot). I will therefore stay in the boot (24 hours a day, except showers) until the one is sufficiently healed on x-ray. This increased protection even when pain has resolved will allow me the quicker recovery that I desire. I am therefore in this boot at least 4 weeks, but probably 6 weeks.


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