What to do about injured foot - don't know where to go with it.

[newnamenellie]

I'm posting here for traffic as no response in General Health.

I’ve been told I most likely have tendonitis across the tendons on the top of my right foot. In a lot of pain and can’t walk properly, been like this for ten days now with no real improvement. In fact, it's become more painful in the last day or so which I think is because I've had to walk more (getting to work mainly) - I can't put my foot down flat at the toes because it's agony. I'm walking with a limp trying to avoid putting pressure on it. Last night it was painful at rest, sort of aching. It hurts to touch too although there is no bruising. It kind of feels as though someone has jumped up and down on it!

I’ve been resting as much as possible but had to walk short distances this week to get to the bus stop for work. Prior to this, I was walking around 4-5 miles per day including to and from work. I'm taking ibuprofen, icing it etc… put KT tape on last night to see if that would help, but it didn't (though I may have done it wrong).

GP told me to go back in four weeks if not better. Was x-rayed at minor injuries when it first became painful but nothing showed, so the assumption was no stress fracture, although I know that these generally don't show on x-rays until they've been present for quite a while, so don't think it can be ruled out.

I'm starting to feel quite anxious that this isn't improving and I'm not able to go about my usual day-to-day life. I don't know what the next step should be (no pun intended!). If I go back to the hospital, I expect I will just be sent away to rest it for longer. I think I may need a scan of some sort but no idea how to get one other than going private.

I've booked a biomechanical assessment at a podiatry clinic but earliest appointment is in two week's time.

TIA

UPDATE

Okay, so I’ve just been to try and get a second x ray. As per the advice of the podiatrist, I went back to the minor injuries department at my local hospital. I checked in and was seen by the triage nurse who said that I couldn’t be seen again in minor injuries for the same issue as its run by nurse practitioners and returning patients need to be seen by a doctor. I was told to wait in A&E and then advised by a second triage nurse to not bother and self refer for physio instead!! She said it seemed unlikely to be a fracture as there was no specific injury event.

I tried to explain that it could be a stress fracture but she was dismissive.

Anyway, the wait was 5 plus hours and the place was filling up with people in varying degrees of need. I was clearly at the bottom of the pile and felt that even when I got to the front of the queue, there were no guarantees of an x-ray as A&E isn’t really geared up for this sort of thing.

So, I left.

Question is, how can I get an x-ray? Should I ask the GP for a referral? Should I go back to A&E when it’s quieter? Do I go private?

I’d be really grateful for any advice.

TIA

Minor injuries unit should be able to do a second xray - ideally 10-14 days at least from the onset of symptoms in order to have a decent chance of seeing the stress reaction.

GP can also refer for an x-ray, but that might take longer to have it done and for a report to be sent back, and then for them to read it and tell you the result and act in it, they should also be able to refer you into an orthopaedic fracture clinic (which don't just see fractures, despite the name).

Pain on the top of the foot like you describe without a definite injury is probably going to be one of three things - metatarsal stress fracture, TMT joint arthritis, or tendinopathy, unless it's one of an innumerable hen's teeth diagnoses...

Thank you @FixTheBone I appreciate your help 😊

As the minor injuries route seems to be closed to me, I think I’ll go via the GP.

Morton’s neuroma can be incredibly painful- worth considering.

I had Morton’s Neuroma, the pain feels generally more under the foot than on top, but it’s not impossible… can also be diagnosed by pressing a finger between the metatarsals to feel the source of the pain. Also a scan will show the enlarged nerve.

OP I can’t believe Minor Injuries treated you so badly, you poor thing! Makes my blood boil.

Go to the GP, get referred for everything - if you can’t weight bear then a bone injury is a serious possibility. You need an X Ray and then an ultrasound or MRI. Also agree a sports physio would be useful but you don’t really want them manipulating stuff until you’re ruled out a break.

Whatever it is, you will find out, treat it and get past this. When you do, make sure you do as much physio and rehab as possible - make that foot (and the other one) as fit and strong as possible again. Less likely to recur. Also worth considering dumping any restrictive footwear you might have. Good luck.

No real advice on where to go from here but just wanted to check that if you're taking ibuprofen regularly for more than 10 days to let your doctor know. They often like to prescribe something to protect your stomach from ulcers. They may not, but worth mentioning about the amount of painkillers you're needing anyway.

It was a stress fracture when I had those symptoms. No specific injury, it just came on. I was lucky that it showed on the first x ray but I'd definitely pursue it. Could the GP refer you back to A and E or the minor injury unit? They couldn't be as dismissive if a GP has told you to go?

Thank you @DailyEnergyCrisis @DrCoconut @MotherOfCatBoy @Wrongsideofpennines

I'm going to try calling my GP practice in a bit (after the morning rush) to ask (beg) for a referral. If that's a non-starter, I think I'll have to go back to A&E at some point when it's less busy.

The podiatrist advised me to wear stiff soled walking boots at all times in case it's a fracture. I've been doing this and it's helping a lot.

I'm wondering if it would be worth investing in an air boot/cast type thing anyway?

@Wrongsideofpennines thank you for checking about the ibuprofen. I'm also taking lanzoprazole to protect my stomach 😊

UPDATE

Thought I'd just update this thread in case anyone else has a similar problem and needs advice.

So, thankfully, I was able to self refer to the NHS physio clinic and even more thankfully, I got an appointment through very quickly.

I went today and saw an extended scope practitioner in the muscular skeletal clinic.

I'm still in the exact same pain as I was when I wrote the post a couple of weeks ago, so I explained all of this to the practitioner. He did an examination and immediately said 'stress fracture' then started sizing me up for a boot. I was then x rayed again and this time it showed something (albeit very insignificant and practically invisible to the naked eye) on my 3rd metatarsal. He's referring me to the fracture clinic for follow up and said to allow 8-12 weeks to heal.

So, I now feel that I at least know what the problem is and what to expect with regard to healing.

The self referral to the physio was the only way I could get a follow up x ray and I'm so grateful that part of the system was so efficient.

Really glad you’ve got an answer OP - good luck with your recovery! Do lots of strengthening exercises when you rehab - I’m sure the physios will tell you what to do.

Im going to give you my metatarsal stress fracture lecture.....

Rest means rest. Not reduce from 20km per week to 10km, but reduce from 20km per week to watching box sets on netflix.... The only people I see that routinely run into issues are people that persist in high demand manual labour because they have no choice and need to pay the bills, or hard-core fitness freaks who have conditioned themselves to secretly enjoy pain...

The pain and swelling is there for a reason, its a carefully calibrated physiological mechanism evolved to limit the intensity and duration of activity while yhe fracture heals - if you're doing things that make it hurt its going to take longer to heal.

Thanks @FixTheBone

I’ve been resting as much as I can, I couldn’t walk far even if I wanted to so no worries there 👍🏻definitely not a fitness freak!

Thanks for taking the time to advise