- July 31, 2019
- Orthopedics and traumatology
- Bondar Fedor
How to determine a fracture or bruise of the foot? Their symptoms are similar. These are also the most common injuries in medicine that occur to people of any age. These injuries can have a wide variety of causes, which arise not only in everyday life, but also during very intense sports, received at work or in major accidents.
To eliminate unpleasant consequences, each person must accurately diagnose these injuries and distinguish between a foot bruise and a possible fracture, since in certain cases a fracture of the foot bones can be confused with a severe bruise, and vice versa.
It is very important to understand that the selection of the optimal method of providing emergency medical care to the victim, as well as the effectiveness of treating the injury, will entirely depend on the accurate diagnosis, since these methods can vary significantly.
So how to distinguish between a fracture and a bruise of the foot (ICD-10 code for the latter is S90.3)? Read more about it.
General symptoms
You should know how to distinguish between a foot bruise and a fracture. After all, the symptoms are similar. The main signs of foot injury are pronounced cyanosis and hematoma, which, however, after a few days can “spread” quite far and high from the site of injury. The patient may also experience swelling and, of course, severe pain.
If a bruise occurs, movement of the foot may be limited for some time. It is noteworthy that this condition can provoke swelling of the tissues surrounding the foot, rather than damage to the foot from the inside. If the integrity of the bones of the foot is compromised, it practically stops moving - any change in position will cause pain, which can also spread to other parts of the body as a result of nerve innervation.
Even without walking, the pain in the foot persists - excessively swollen surfaces, as well as displaced bone fragments, press on the soft tissues from the inside. A reflexive contraction of the muscles occurs, they try to move into the desired position, but this causes pain to increase again.
A characteristic symptom of an existing fracture is considered to be a very pronounced hematoma - due to a violation of the integrity of the bones, damage to all vessels occurs, and internal hemorrhage may occur. With certain types of foot fractures, the hematoma will appear only 1-2 days after the injury, since the bone is surrounded by a dense layer of muscle.
Visually it is easier to identify a foot fracture in a person: the leg may look unnatural, it can be bent in places without joints. When feeling the fracture site, the doctor can feel the bone fragments and even hear a characteristic crunch.
All open wounds, if any, must be carefully treated to reduce the risk of infection. If a person does not have a tetanus vaccination, it is imperative to carry out emergency prevention - treat the wounds with special antiseptic compounds, and also administer tetanus toxoid.
Causes
A fracture of the foot bones occurs:
- from an incorrect jump;
- powerful blow;
- falling from a height;
- unsuccessful turn of the leg.
It happens that the foot is exposed to stress for a long time, due to which micro-cracks or stress fractures can occur in the foot. The most sensitive are the talus and metatarsal bones.
Often, discomfort or pain that occurs in the foot is not particularly frightening, but should alert you. After all, after receiving even a minor injury, the integrity of the bone conglomerate may be disrupted - a bone fracture may occur, and the consequences may be different.
Foot bruise
A foot bruise, ICD-10 code S90.3, is an uncomplicated injury to the muscles, subcutaneous tissue, and skin, without compromised integrity. The main symptom of a bruise is severe pain in the leg area, which occurs almost immediately.
Blueness of the skin may also appear after an injury or after some time has passed. The result of a bruise may be a small hematoma or swelling. After a few hours the pain becomes more pronounced, it becomes sharper and sharper, after which it can become dull and aching.
If the risk of fracture is completely eliminated, the pain subsides after a few days. But it is important to remember that if the pain increases, you should urgently consult a doctor. In the first day after a bruise in the foot area, the swelling may increase slightly.
The appearance of a hematoma
A hematoma is a consequence of hemorrhage in the soft tissues of the foot. Its size and shade will be primarily influenced by the force with which the blow was struck. When the subcutaneous fatty tissue is affected, the bruise usually appears immediately 1-3 days after the injury. If the damage is very deep, the hematoma may not manifest itself at all.
Doctors also note that the hematoma will gradually change its shade: a fresh one has a bright red tint, but a little later it may acquire a purple color. On days 4-5, the hematoma has a dark blue color, and after that it becomes slightly yellowish.
Localization
Typically, a foot bruise (swelling is its first symptom) varies in a specific area. For example, in most cases the toe area is affected, while the heels and soles are much less likely to be affected. This especially happens if the patient does not have displacement of impacted, subperiosteal and incomplete bone fragments.
The main difficulty in diagnosing a bruise is that the signs described above may indicate a closed fracture without detected displacement. In such a situation, it is impossible to establish a reliable diagnosis without tomography or fluoroscopy.
If edema begins to develop, this is most likely due to excessive accumulation of fluid in the tissues of the limb and their deformation. Typically, swelling subsides after a few days, as well as after removing a previously applied pressure bandage.
It is worth learning more about how to distinguish a bruise from a broken leg.
Signs
Signs indicating a bone fracture in the foot may differ, depending on the affected part:
- If the heel is damaged, the main symptom will be the appearance of swelling and hematomas that appear a little later, located below the level of the ankle. The swelling quickly grows, the outlines of the heel become blurred, and when you touch it, the person experiences pain and practically cannot walk.
- If there are fragments that have shifted, the pain can also spread to the calf area. If a compression fracture occurs, the arch of the foot may swell, and it may become significantly larger than the other foot.
- If the fracture occurs in the talus, the patient may experience pain and increased swelling. These signs will intensify upon palpation. Bleeding into the joint may also occur. It becomes difficult to move the leg, and the contours of the joint are usually disturbed. It is difficult to diagnose a fracture of the talus using these symptoms alone, and it can be differentiated as much as possible by spraining the ligaments in the foot. To establish the correct diagnosis, you need to monitor the presence of two characteristic symptoms: the localization of swelling from the inside of the leg, which reaches almost to the middle part of the ankle joint, and the second symptom - increased hemorrhage.
- When a fracture occurs in the neck of the bone, a lump may form, the skin becomes blue and becomes very stretched, and discomfort is localized in the front. When the posterior process is injured, pain occurs mainly in the heel.
- When there is a fracture in the metatarsal bone of the foot, the main symptom is swelling located near the sole. Sometimes it spreads to the outside of the injured leg. In most cases, the metatarsal bone of the foot is deformed, and when trying to walk even a little, the patient experiences pain.
- If the phalanges of the fingers are damaged, the victim exhibits signs characteristic of simple fractures. Moving your fingers on a limb is quite painful; you can stand on your foot, but the person feels significant discomfort and notices swelling. Often, a hematoma on the nails is added to a fracture of the phalanges on the feet.
If there is a fracture, even after several hours the pain will not subside, becoming more pronounced and severe. If the patient was diagnosed with an impacted fracture, without involvement of soft tissues, hematomas will not be detected.
When fragments of the bones of the foot are displaced, it will be much easier to recognize the fracture: the foot can be deformed, shortened or lengthened compared to the uninjured leg.
Features of damage
Over the past year, only 10% of patients went to the emergency room with a foot injury. Such a small percentage is due to the anatomical features of the structure of the foot. The bones that make up the lower part of the leg are small and located very close to each other.
The causes of a fracture can be indirect injuries:
- Jumping from a swing or any height;
- When walking, twisting of the leg;
- A heavy object falling on your leg.
Since the bones in the foot are closely connected, a fracture of any of them leads to deformation and changes in the functionality of the entire lower part of the leg.
In adolescents and older people, a foot fracture can be caused by flat feet and improper support on the limb. If not treated promptly, the injury causes arthrosis, and the person loses the ability to move the foot normally for life.
People whose lives are connected with sports, women over 45 years of age and the elderly are at risk. Women experience hormonal changes after menopause. The body stops absorbing calcium and fluoride in normal amounts. Bone tissue loses strength, becomes fragile and vulnerable. Any mechanical impact on the foot causes a fracture.
Children suffer mainly due to active games. A child gets injured while jumping from a swing or any structure. The foot can also be damaged if a heavy object falls on it. Men whose activities are related to construction work are more likely to go to medical institutions with such injuries.
"Stuck heel"
In an adult, the symptom of a broken foot may appear as a “stuck heel”: it is difficult for a person to tear the leg off independently from a lying position. The crunching of fragments may even be felt when palpated. Also, this condition is observed in the absence of a process of pinching of the muscles located between the fragments.
If a patient has a closed foot fracture, doctors may note pathological mobility of the foot outside the joint. It is extremely undesirable to independently check the possibility of mobility of the victim’s foot, since this can further damage the blood vessels and nerve endings, as well as displace fragments.
Open fracture
Another option for distinguishing between a foot bruise and an open fracture is below. An open fracture with a violation of the integrity of the skin in the foot is easy to identify, and anyone can do this simply by feeling the foot. In an open wound, bones may be visible, swelling may increase, and the foot may bleed.
There are times when pain from a fracture in the foot may not be felt at all. This is especially true when there is excessive production of adrenaline. Swelling can appear almost instantly or grow over time. The length of time a hematoma lasts will also be influenced by the amount of muscle tissue available surrounding the injury.
Rehabilitation period
How long is it in a cast for a broken foot? Everyone will have to wear a plaster cast differently, but on average this period is 1.5 months. The need to remove the plaster is determined by a control x-ray examination after this period.
After removing the fixing bandage, you need to constantly develop the damaged foot, using:
- massage of the lower leg and foot;
- special physical therapy exercises;
- physiotherapy;
- shoe instep supports or special orthopedic shoes.
Traumatologists recommend wearing special orthopedic shoes for a long time during the recovery period.
Massage and physiotherapy for foot fractures is an integral part of the rehabilitation period and is selected by the doctor individually for each patient.
The rehabilitation period depends on a number of factors:
- complexity of injury;
- nature of damage;
- age and health status of the patient.
For a foot injury, rehabilitation can last several months. The exception is the phalanges of the fingers - they grow together quickly thanks to proper treatment.
How to distinguish between a foot bruise and a fracture?
Only an experienced doctor will be able to identify the existing nature of the damage, if necessary, using additional diagnostic methods: for example, computed tomography and radiography. Therefore, if there is minimal suspicion of a fracture, it is not recommended to load or move the bruised foot in any way.
If you bruise your foot, you need to apply a bandage or splint to secure the injured foot. In order to promote contraction of blood vessels, cold should be applied to the bruise and pain medication should be taken.
In case of an open fracture, you need to apply a sterile bandage to the foot. If the case is particularly severe, the doctor may prescribe heat application to the foot. You should also quickly go to the hospital, where the doctor will perform the necessary tests and prescribe the correct treatment, depending on what happened to the foot: a bruise or a fracture.
Prevention and recommendations for eliminating relapses
In order to prevent a fracture, it is necessary to try to maintain safety in one form or another of life activities. You should not unjustifiably risk your life, because the payment for this can be quite high.
If your foot has been injured or there is a fracture, it is important to consult a specialist in a timely manner. Only a doctor can decide how treatment should be carried out. He selects one method or another, effective drugs with the required dosage strictly individually.
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