How do you know if you need an X-ray?

[SinkGirl]

Sounds stupid really but how do you know if something is just bruising or whether it needs an X-ray?

Slipped down the stairs and really hurt my foot this morning (stair gate 1, my foot 0). It started swelling very weirdly right away and looked like bruising was coming up right away. I had an egg shape over my big toe joint but now the swelling is spreading across the top of my foot so it’s less defined. Really hurts to move my toes and less movement than the other foot.

The pain was excruciating but subsided to manageable levels within a few minutes. Until then I was making unholy noises 😂

Only place with an X-ray here is A&E and I am most definitely not going to A&E on a Saturday. If I need to go I’ll go early tomorrow.

It bloody hurts but surely if it was broken I’d still be in agony hours later? Then again I had an horrific ankle injury years ago where my whole foot and lower leg was swollen and purple and that wasn’t broken so who the hell knows.

What would make you go and get it checked out vs waiting it out? I have twins to chase around and don’t want to do any damage by leaving a fracture. I can walk on my heel but not my whole foot. This was ten mins later and then a few hours later - swelling is more spread out now.

(Apologies for any hairiness )

A&E would be my advice.

Definitely A&E, sorry.

The Ottowa Ankle Rules are used by medics to decide if films are needed for ankle and foot injuries.

Ball bags. Thanks - will go in the morning. DH has just pointed out that my big toe is at a really weird angle compared to the other so I guess I have no choice. I really hate going to A&E unless I have something literally hanging off (which actually happened once, almost amputated my arm). I have form - once walked around for six months on a fractured ankle and then hurt it far worse (yes, I’m stupidly accident prone).

I wish we had a minor injuries unit - it feels bloody ridiculous going into A&E with a sore foot!

If you don’t have a minor injuries your a&e will likely triage minor and major injuries seperately. You won’t be in the same queue as the heart attacks don’t worry about it. You’ve got to use the only resources available to you.
I’d go for swelling/deformity for sure.

go now (before the drunk evening crowd)

getting pain relief & a boot or plaster will really help with the pain. I doubt you would sleep much otherwise.

My initial untrained medical opinion is that it might be dislocated? You wouldn't want to leave that overnight!

Yes they definitely do triage separately, but I still feel like a wally!

There are actually two MIUs having looked - one is 1h5m on the bus but closed on weekends and the other is 1h55m on the bus. Absolutely no chance I could manage that. Wish they had a separate one at the local hospital.

Can’t go tonight, it’s honestly insane in there on a Saturday, early mornings are quiet though (had to take DT1 in to have his head glued a few months ago and we were in and out in less than an hour) so I’ll hold on - I can manage til then, our twins don’t sleep much anyway so I’m used to sleep deprivation! I’m actually on morphine for another condition so have to be careful that it’s not masking pain if anything.

I don’t think it’s dislocated, I think it’s just the swelling making things a bit wonky. I will definitely go in the morning, and if it suddenly becomes unbearable I’ll go sooner - would just rather avoid the drunk tank if I can (they’ll already be there now - stag and hen town!)

The swelling just looks oddly localised.

If you're insistent on leaving it overnight just make sure with your eyes closed! That your husband checks you have good sensation in your toes and keep it iced and elevated.

Purely from the photos you need a foot X-ray rather than an ankle X-ray.
I broke two bones in my hand, my hand was massively swollen but it didn’t actually hurt much.

Go to minor injuries in the morning. In the meantime keep it elevated. Ice will help reduce swelling and take paracetamol for pain.

Yes my ankle feels fine - if anything is broken it’s my foot near my toes or I guess the base of my big toe. I don’t think it looks too bad now but DH disagrees - the swelling has spread out more so it’s less obvious but there’s definitely bruising coming up below the surface.

Got ice on it now and taking regular painkillers. Thanks for all the advice. Maybe I’ll get lucky and it will be miraculously improved in the morning :)

The Ottowa rules are to aid the Medic's decision on whether to request a foot OR ankle x-ray. It can be difficult to separate the two anatomical areas ya see.
I would be having rest, using ice and elevating my foot. Call 111 and they may be able to offer an appt for the out of hours GP (usually based in an A&E dept) so you don't have to wait in the queue and be triaged with the rest of the rabble.
If you don't manage to get it seen to this weekend then definitely phone the GP surgery on Monday.
Hope you make a swift recovery whatever it is :)

soft tissue injuries can hurt more & take much longer to heal than a break; a break can be better outcome.

I would see how I felt in morning.

Go to your local emergency department in the morning, if it's dislocated the minor injury unit, assuming it's a stand alo e service, would have to send your there anyway to see an orthopod. Take pain killers regularly, this will not interfere with your assessment. Good luck

DH broke his big toe and decided to just leave it to fix itself. It was a bad decision, and 5 years later he's still trying to get it fixed, learn to walk properly again, etc.

Your poor DH! That’s my worry - I really messed up my ankle by not having the fracture diagnosed and I’ve been prone to injuries in it ever since.

The swelling has definitely come down a bit after an evening of ice but the bruising is coming. Will just see how it is in the morning I think. Maybe it will look and feel much better but I’ve got an alarm set early so I can get in and out and hopefully not be too much of an inconvenience if I do have to go. There is an OOH GP at the hospital but they’d just send you to A&E for a possible fracture.

In a few years the local A&E is closing so hopefully they’ll have a MIU there then!

Go to ED, the OOH GP/ACP can't tell if it's broken with the seelling & bruising you've had, you need an x-ray

I hurt my ankle in the summer. It also swelled up and was very painful. Because it's not an emergency I went to the small injuries clinic (or similar name) not a&e where you would be waiting ages as low priority.

The nearest one was an hours drive as there isn't one in my local hospital but it was worth it as I was in and out and xrayed within the hour.

It looks much better this morning and rhe swelling is less so I have a bit more movement but still very painful. Still can’t lift my big toe. I know I should still go, just feel like a bit of a time waster! Just getting myself sorted out to go now.

No break fortunately so should hopefully get better in a week or so (I hope). At least I know. They were really nice and said I definitely did the right thing getting checked out so don’t feel so bad now.

That’s good news! (although I’m sure it’s still painful)

Well done - hopefully it will heal soon.