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Desperately need advise re: a recent severe foot injury (HMO patient)

Posted by Kathie F on 11/29/01 at 12:28 (065632)

I am dealing with an HMO and I feel they are not doing enough testing to discover the real extent of my injuries before diagnosing and treating me.

On 8/26 I injured my foot by stepping in a hole. My right foot went into the hole with inside edge of the ball of my foot behind my big toe first. The other toes folded up over my foot...the whole foot bent to the inside...I wend to the other way and fell on top of my foot.

I suffered from extreme pain for almost a week. My foot was almost completely black (especially on the bottom). The appearance of my foot was like a severely club foot with very fat toes sticking out of the end.

I was originally sent to a podiatrist who then sent me to an orthopedist who casted my foot (incorrectly). After 6 hours I was in such pain I had to go into the ER and have the front of the cast cut off. I wore the remainder of the cast as a splint for 6 weeks. When I saw this doctor again he simply told me I should start walking on it. This was impossible as there was still excruciating pain when I applied any pressure on the foot. He ordered an air cast for me which worked well for the pain but seemed to increase the swelling. Also during this last visit I asked him if he would order an MRI as I wanted to know the extend of the soft tissue damage, etc.. He looked at me with disgust and said that most people trusted his diagnosis, stormed out of the room and I never saw him again. Whatever I received from his office after that was through contact with his nurse. I want to make clear that the reason I asked for the MRI was that even though the foot was clear of the black color it was still very red and discolored (like there was a circulation problem). Needless to say I did not receive the order for an MRI from him and I changed primary care physicians so I could have access to a different specialist.

My current symptoms are discoloration of my foot and leg, swelling of my foot, ankle and leg (the ankle and leg were not injured in the fall), and pain in the ball of my foot where the second and third toes connect to the ball of my foot. By the end of the day that area is bright red.

This new doctor x-rayed my foot and determined there had been no breaks and feels I have RSD and wants to do complete nerve blocks to my foot.

I'm uncomfortable with this as no one has tested the circulatory system in my foot to see if I might have sustained a major injury to a vein or might I have a blood clot which is inhibiting my circulation and causing the discoloration and swelling?

Please advise me of all the tests that need to be performed so that an accurate diagnosis is made before treatment.

Sincerely,
Another victim of an HMO

Re: Desperately need advise re: a recent severe foot injury (HMO patient)

DR Zuckerman on 12/01/01 at 09:58 (065810)

Hi,

You could have RSD. The discoloration changes are one indication . Three phase bone scan can be helpful. Comparative x-ray of the opposite foot are helpful. The most important aspect of RSD is to get treatment by a specialist in RSD. Local anesthetic blocks aren't the thing to get if you have RSD. You may need epidural injections. SO PLEASE DON'T get to a pain management speciaslist now. Waiting can and will leave you will pain for the rest of your life.

Re: Desperately need advise re: a recent severe foot injury (HMO patient)

DR Zuckerman on 12/01/01 at 09:58 (065810)

Hi,

You could have RSD. The discoloration changes are one indication . Three phase bone scan can be helpful. Comparative x-ray of the opposite foot are helpful. The most important aspect of RSD is to get treatment by a specialist in RSD. Local anesthetic blocks aren't the thing to get if you have RSD. You may need epidural injections. SO PLEASE DON'T get to a pain management speciaslist now. Waiting can and will leave you will pain for the rest of your life.