Poss foot . Too late for A&E, not right for walk-in centre, so where do I go?

[moosemama]

I fell down a hole on the beach holiday, inverted my ankle and thought at the time that it was just a bad sprain, so did the usual homecare stuff and have kept off it as much as possible.

It's now almost two weeks since I did it and as the ankle swelling subsides I am noticing more and more pain at the base of my 5th metatarsal, which is particularly bad first thing in the morning and gets worse as the evening goes on as well. I'm thinking it could be an avulsion fracture, as I had exactly the same injury two years ago, but on the other foot and the pain, swelling and progression of symptoms has been almost identical.

Last time our local A&E failed to spot the fracture and I ended up going to my GP 10 days later, who just sent me straight up to A&E in the city. What I'm now wondering is, do I need to bother with the GP again (seeing as last time they basically said they couldn't do anything and I needed to go to A&E for an xray) and where is the best place to go anyway.

I am conscious that it isn't an emergency, so don't want to go to A&E. Ideally I would like to go to a minor injuries unit as it seems they would be best suited to deal with it, but we don't have one in our area.

We have a walk-in centre, but it says cuts, minor skin injuries and non-life threatening or urgent illness - they don't have bone-injury assessment facilities.

I really don't want to go and waste anybody's time. I know how overstretched these services are and it seems such a waste of both their and my time to go to the GP and then on to A&E when I can hobble around, so it's not exactly urgent and is definitely not life-threatening. On top of everything else its blooming Bank Holiday weekend, which means if it does turn out to be broken I will have to wait until the middle of next week to get into the fracture clinic.

Honestly, what a faff. I am such a klutz.

Any advice would be really appreciated.

Ring the A and E department and ask.

phone NHSDirect and ask them. They may have a clearer idea as to the best place for you.

Why don't you ring your GP surgery and ask them? Our area has a GP-led Xray unit so you collect the referral form from the GP and it is great for avoiding the wait at A&E. They may have something similar or be able to refer you in some other way.

Thank you for responding so quickly.

I have been trying to get through to my GP all afternoon to ask their advice with no luck so far. If I book an appointment with one of the GPs I strongly suspect all they'll do is send me to A&E like they did last time.

Tommy, good advice, I was hoping to circumvent calling NHS direct by using the wisdom on MN, as it's always such a pita with a huge long list of standard questions to find out if I'm having a heart attack or have meningitis, before they end up saying 'Go to A&E' where you are promptly told you shouldn't have wasted their time. Realistically I may have to call them if I can't get through to my GP soon though.

Go to GP and get an xray referral form, then just go staright to nearest place that does xrays.

Sorry lisaro, I meant to say, I didn't want to call A&E directly, because I always worry about holding up the line for someone with a more serious problem.

Ninja, are you a nurse? Is that standard practice then?

I wonder why they didn't do that last time instead of sending me to A&E 10 days after the injury occurred?

I will keep trying the GP then. I think it must be busy with people trying to get in before the bank holiday, but they do have a phone triage system, so I should hopefully be able to get in tomorrow. (Too late for this evening, as they shut in 25 minutes.)

Go to a&e, just not night, evening or weekend or you'll wait for ever. I work in a&e and we see people with stuff a LOT more trivial than this! After 10 days fracture will be obvious on xray.

Hi,
I have never posted on here before (gulp), but thought I may be able to offer a little advice. I am currently in cast having fractured my 5th metatarsal for the second time and having had to have surgery this time around. I understand that A&E can be tiresome and lengthy (i waited 5 hours this time around, eek), but walking around on a potential fracture may make it worse. The first time i did it i could hobble around a bit and left it a day before I went, by which time it was very painful, very obviously broken and is still not fixed 8 months later. It seems that with these injuries, getting the right help ASAP might work out in the long run. Good luck, I (genuinely) hope it is nothing serious.

Thank you pyjamalover. It's really reassuring to hear that they won't think I'm wasting their time. I have ultimate respect for anyone who works in A&E.

Finally got through to my GP's at 5.00 this evening. Explained what has happened and they told me to go to A&E, explain that it happened on holiday and tell them the GP's sent me there. Dh is working away today and I have no childcare this evening, so am going first thing tomorrow morning.

HairyClairy, thank you for posting. So sorry to hear you have fractured your 5th met. Yours sounds much worse than mine if you needed surgery. I hope it heals well and quickly. My last 5th met break (other foot, 2 years ago) was an avulsion fracture and I was in an aircast for 10 weeks starting 12 days after the initial break. I still get pain in that foot even now.

I'm managing to hobble around, but really only using the inside of my foot and if I don't keep it raised, my whole foot goes purple. Also seem to be developing an odd shaped bruise over the site of the worst pain, which is exactly where my other fracture was.

How was your xray?

Hi, thanks for asking. I'm actually just back.

I have a fractured little toe, but too late to strap so no treatment there.

They took three films of my foot (aerial, and lateral left and right) and two of my ankle, as there was a distinct tender spot over the external joint.

Nothing on the ankle, so that's good.

5th Metatarsal is a different matter. It's obviously swollen and very tender, but no sign of a fracture. The nurse said she was very puzzled, as given the swelling, pain and the way I'm walking she was sure it would come back with a break. She showed me the aerial film and there is no sign of an avulsion, although there is one further back towards my heel, that she said looks too rounded and must be an old break (although afaik I've never even sprained, let alone broken this foot before). There is also an odd sort of spike out of the side about a cm below the top of the 5th met, but she felt that it was probably just my natural anatomy, rather than a break.

Unfortunately, they didn't take xrays from the underside of my foot and that's where the pain is, it hurts from the base of the joint across inwards towards the arch of my foot. (I did reiterate that the worst pain was underneath.)

The consultant will review the films and call me back if he is suspicious, but the on-duty doctor said they were happy to agree with nurse. The consultant will agree as well though, as there was nothing showing on those angles.

Last time, the same hospital missed the fracture, but when I was sent to the big hospital 10 days later they took 9 films and found it straight away.

Their best guess was that the pain must be from the sprain, but as there is minimal swelling and I've had almost no bruising that seems unlikely. It's two weeks today since I fell down the hole.

I had a fracture and my foot was black within minutes, and still so 10 days later when the cast was put on. I had an avulsion fracture, and it was only picked up when the consultant saw the films the next day as they are pretty tricky to identify. I was walking on it for a week as my DD had chickenpox.

My foot was very swollen too. A sprain can be just as painful, and treatment is very similar.

I think the pain on the underside of your foot is most likely caused by the sprain. Unfortunately sprains can take a long time to sort themselves out. You will get pain and discomfort for a while. Two weeks is very early days and your foot will need a good six weeks or more to recover.

Sorry to be so gloomy but I sprained my ankle a few years ago and was hobbling around for ages.

Valium, that sounds nasty. I think mine confused them last time because it didn't bruise badly. That's basically because I have over stretchy ligaments etc anyway, so they overextend rather than snapping or tearing badly - which is good in some ways, bad in others - and still hurts like hell.

Orange, thank you. I think I'm only concerned because the underfoot pain is very different to the rest of the sprain. It feels the same as the fracture did on my other foot and goes from a sort of nauseating throb to seriously bad if I move the wrong way or put the left side of my foot to the floor. It feels very like the type of pain I have in my broken toe, which to be honest isn't all that bad, but much much worse.

The ankle/sprain is an obvious soft tissue, ouchy pain with the odd bit of 'big OW!' if I twist or move suddenly. The swelling has nearly gone from around the ankle area (just some left just under and to the side of the outer ankle bone) and there's hardly any bruising. Even the nurse who examined me said she was convinced there was a fracture from the swelling over the site, plus my reaction to her examination and how I was walking.

Also slightly concerned that the nurse said she felt a couple of suspicious areas on the xray were probably old fractures, when I have never injured this foot before in my life. My other foot - yes, several times, but never this one - until now. I suppose if the consultant disagrees I won't hear until after the bank holiday though.

The pain was awful last night after it had been poked and prodded examined twice at the hospital. I'm usually very stoic about pain and have a pretty high threshold, but there's something about this underfoot pain that I can't cope with, it nearly made me throw up a few times now when it's suddenly happened as I moved.

I was very surprised I had a broken little toe. I can't really get my head around how I managed to do that from an inversion, especially when my feet were laced into MBT trainers at the time.

Last time the sprain took longer than the fracture to heal, although I do wonder how much of that was because it was immobilised in a cast for so long when really it needed to be being exercised and strengthened.

All I can do is carry on with the rest, ankle exercises and keeping it raised when I can and go back in a week or so if it's no better. Total pita though as I have so much to do and none of it is easy on one foot. I wish they'd at least given me a crutch so I can stand up up and get on with things.

I used a stick and it really helps. I hurt my foot 6 weeks ago, and I now just have a moon boot which I wear for going out only now. It is still painful. It does not help that I am 31 wks pg and have a 2yo to chase around. I am hoping to drive from Wednesday when I am reviewed again.

All the bits in your foot are linked, so it could be pulling on tendons and ligaments that broke your toe possibly?

I think you have an avulsion fracture. I had pain down the left side of my leg, indeed still do, due to all the bits being linked. Do you need to work or drive? If so I would encourage you to go back on Tuesday.

I would not be doing any ankle exercises either, and rest as much as you can. Can you put a crepe bandage or tubigrip on it or something? take it off to sleep though.

The hospital told me I should be doing regular ankle exercises. Nothing major, just flexes and circles, to stop it seizing up.

I do have a stick, but feel daft using it if the hospital didn't think I needed one. Last time I had a knee length aircast and 2 crutches and was able to push dd's pram whilst walking on the school run. This time I feel so frustrated that I can't get about, despite being 'seemingly' less injured.

I think you must be right about the tendons pulling my little toe. It's not an avulsion though - it's a very clear horizontal crack, so I guess it must have been snapped back and cracked that way.

Fortunately I don't work or drive and the dcs aren't back at school until Tuesday after next, but I have a raft of hospital appointments coming up for the dcs over the next week, so it's looking like I'll have to rearrange those - none of them are desperately urgent, thank goodness. Also need to buy the boys' school shoes, but can't see me getting into town now. Hoping dh will do it tomorrow.

I really can't face bandaging it, it's so tender to touch, it feels like that will just make it hurt more. I am sitting with my leg raised and a really soft pillow butted up against the ball of my foot, because it's worse if I let it drop forwards (my feet don't stick up naturally when lying down like most people's, they flop forwards due to hypermobile joints).

Oh - I am such a pathetic grump aren't I?

It really does not sound right at all. My concern would be if it is a break the exercises could aggravate it.

You would be bouncing about if you could! So you are not being a pathetic grump.

I am in Scotland so the kids have been back for a week now. I hurt my leg a week into the holiday so could not go camping or any of the fun days out I had planned.

Do not worry about the stick. If it helps, use it! I need mine as I feel quite wobbly with my bump too. My PGP is coming on as well now

Oh you poor thing PGP has probably been set off by you favouring your bad foot. I've had SPD type pains from limping about and I had my dd three years ago, so it's bound to be worse for you.

When I did my other foot (lordy I sound so accident prone - I'm not, honest ) I did it just before the schools broke up and was in the aircast until well after they went back, so the whole summer and then some. We went away on holiday anyway and it became a bit of a family ritual seeing how much sand I could pour out of the aircast when we'd been to the beach! Mind you, it's not easy to manoeuvre on sand with one of those things on your leg and crutches. Not my most ladylike beach entrance/exits ever!

Am completely missing the bank holiday weekend as well. The only upside is that I've now managed to beat ds1 on the World of Goo game app. or rather

Dh has been out with the dcs all day and I've been stuck on the sofa with my laptop. He has now returned with a supply of cocodamol. I found two in the first aid kit last night and it's the first night's sleep I've had since I did it. Think I'll stick to paracetamol and ibuprofen in the day though and just have one lot of cocodamol before bed.

It is accident and emergency though.

I took my son when he fell and I couldn't stop his nose bleeding. I asked about taking him and saying I wasn't sure what to do. I was told if an accident had happened then A & E as the place to go.

It's a shame it's the other foot or you could wear the air cast boot to help with the pain.

I cannot bear sand!!! Especially a wet kid covered in it. Would rather run my fingernails down a blackboard.

I wish I could have Brufen and wine!

JustFabulous, I was worried that the accident happened while I was on holiday rather than being recent, iyswim. I thought they'd throw me out and make me go via my GP for an xray. As it turns out they were absolutely lovely. There was hardly anyone in there though, so maybe that helped.

Hope your foot is better soon.

SauvignonBlanche, the irony is that I only threw the aircast away in July.

I should have known that was tempting fate!