puzzling foot injury

[dizzydancingdude]

My friend's patio door came off its runner and landed on her foot. She had a huge bump; on her foot, just above her toes and a deep, though small looking cut at the point of impact. The rest of the top front part of her foot was swollen. She was told in Casualty that there was tissue damage and damage to the tendons but no apparent broken bones. A few days later when some of the swelling subsided she began to walk on it. It ached but every so often she got a sharp piercing pain on the top; and underneath her foot. From the point of impact to her 2nd toe she could feel something like a very thin raised matchstick.
Over the past 4 days, - a week later, the foot appears to be fine for several hours and then it will ache badly and the severe sharp pain returns every so often.
She is wondering what the thin matchstick like thing could be.... she thinks it’s a bone but could it be a tendon?
She's quite stubborn in not wanting to seek medical help again!! but is puzzled as to why the foot seems to be better and then the painful achiness and the sharp pain occurring at intervals returns.
Obviously the foot would need to be examined before an accurate diagnosis could be made.... but what could the thin matchstick be and why do both pains come and go so suddenly?

[JainMD]

Hi,
How is your friend feeling?
Achy sharp pain which comes and goes is always due to nerve entrapment or nerve irritation.
Did the doctor say the injury has dampened the nerve too?
The tendon too can cause such a pain, but I believe there is nerve injury.
Keep me posted if you have any queries.
Bye.

[dizzydancingdude]

Many thanks for your reply!
I persuaded her to go back to our A & E - Minor Injuries Unit today as she was in considerable pain last night. The Nurse got a 2nd opinion when she saw it... The puncture hole goes deep down to the tendon and the tendon and a blood vessel has been ruptured.
She has had a tubular bandage put on it, told to keep it up but move it around when sitting and go back in a week if no better to arrange for physiotherapy. She asked why the pain eased off and then the next minute be sooo painful and was told 'because its a tendon' which she felt didn’t really answer her question fully. She can also feel as though something is clicking. She was told to walk properly and put her whole foot on the floor. She screams out in pain at times - and she isn't a 'wimp'

So why do the achy pain and sharp pain completely go and then return so severely?
I'd be interested to hear your thoughts about it and of the best ways of recovery.

[JainMD]

Hi,
How are you feeling?
The symptom of sudden, sharp, shooting pain suggests that there is nerve involvement causing nerve irritation and hence the symptoms of pain.
The thin matchstick like thing could be bone fragment or a dissected tendon, but I feel it is bone fragment.
An imaging study would reveal the actual pathology.
I think you can persuade her to visit an orthopaedician for further evaluation and imaging study as right intervention at right time is more beneficial and healthy.
Keep me posted.
Bye.