Crush Injury to foot 6 months ago with chronic pain and persistent swelling

[Kate0508]

In Sept. 2010 approx. 4000 lbs of steel fell off of the top of a forklift on to the top of my husband's foot.  He went to ER and had XRAY.  The Xray didn't show a fracture.  He didn't experience any pain or swelling until approx. one and one half months later.  Since that time, the pain has increased and is constant, as well as the swelling.  The pad on the underside of the foot along the toe area is constantly swollen - being less swollen in the AM and gradually increasing throughout the day - even though he does not walk or stand on the foot.  He had a MRI that did not show anything the podiatrists felt to be significant, even though I question that.  We also asked about potential "compartment syndrome" and the podiatrist said that he is 100% certain that he does not have compartment syndrome. Both podiatrist administered a steroid shot that provided relief for approximately 3 to 3 days.  He's tried wearing different "boots" without success - the boots cause the pain to worsen.  The only advice the podiatrist has is to stay off the foot and apply ice packs intermittently throughout the day.  This has been going on for four months with no decrease in the swelling or pain with the pain increasing in intensity.  

My husband has an appointment with a pain management clinic this coming week and we are considering trying a 3rd podiatrist - even though we don't know how to select one - as the podiatrist he has now seems to be very good.

Any recommendations are greatly appreciated.  Thanks, Kate

[nurseaudrea]

CRPS is very very rare and it can also cause the skin to change texture as well. It usually is a tactile pain inducing syndrome meaning when someone touches it it will hurt like fire. Does he do that?Usually the person with this can not handle anyone touching no matter how slight. It is kind of like reflex sympathetic syndrome, also called reflex sympathetic dystophy syndrome. Has many of the same features but is not known to jump limbs or move to other areas of the body. This is way more common and caused many times by injury.

[SLCPMOM]

Dear Kate,
I'm sorry to hear about your husband.  The swelling this late after the injury usually does indicate a problem.  If he is experiencing color or temperature changes along with swelling, it may be CRPS (complex regional pain syndrome.)  I would make this guess because MRI results were negative.  It can happen after injury or surgery to an extremity.  Unfortunately, no one really knows why or how it happens.  CRPS has also been known to "jump limbs" from one side to another.  However, it can be treated, usually with procedures, medications, ect.  One of the procedures that is very commom for this condition is called a Lumbar Sympathetic block.  I wish you and your husband well.  Please let us know how it goes.
SLCPMOM

[nurseaudrea]

If he had compartment syndrome you would already know by now. The swelling is so bad that the tissues get no blood flow from the vessels being too constricted. Your doctor would know immediately if that were the case so rest assured. Have they checked for stress fractures in the foot? My mother had them for months before she was diagnosed. I kept telling her to get second and third opinions and to have another MRI that finally showed them. Ask the podiatrist if the Radiologist saw any stress fractures? Or better yet get the report yourself so you know what it says. You can always come to this site and ask what it means. There are several nurses on this site that could help you with that. Never hurts to know what your reports say. Also meant to say Wow 4000 pounds? Sounds horrible.

[randy231]

I dont have a clue what to do but I feel his pain. I had both my feet crushed on 1-10 and left foot has been "crushed" and right foot to a lesser degree with a broke ankle. Oh yea, the left foot has "multiple fractures". My specialist says that there isnt anything to do but let it all heal. My feet swell up so big they look like balloons with toes.