Ds' foot injury--should I request an MRI? Any advice?

[Harriet Vane]

Hi,

 

My ds, aged 9, injured his foot almost two weeks ago while trying to dismount mil's exercise bike. He was not screwing around or misbehaving. It's an old wind bike, and as he was trying to get off, the pedals continued rotating, and his foot was smushed between the pedal and the body of the bike.

 

The initial diagnosis was contusion. Five days later the swelling was down but ds still had pain in a line from the big toe to the base of the ankle (front/top of the foot). An x-ray at that point showed that there is no hairline fracture and no damage to the growth plates.

 

As of yesterday the podiatrist wrapped his foot in a soft cast (looks like soft cotton tape, topped by a heavier fabric tape) and ordered heat twice per day and continued rest. (Ds has been on crutches for two weeks and has been really, really good about not using that foot.)

 

We are going to family camp in a week and a half.

 

--Should I request an MRI?

 

--Any advice in general for dealing with this injury?

 

--Do you know of any type of waterproof options for this problem? Keeping him dry right now is not an issue, but it will be for family camp.

 

--Should we push for physical therapy?

 

We are badly overwhelmed about family camp. Ds is very, very athletic and usually spends the week running with a pack of boys all over the woods and beach. The running is absolutely constant. There are also daily hikes in the children's program. Some questions for that:

 

--Can you share your experience recovering from a foot injury?

 

--We normally stay in a tent. We might be able to get a room in the lodge instead so that we are at the heart of the activities rather than at the edge of camp. Should we do this? Or expect ds to use crutches getting to and fro?

 

--Waterproof foot wrapping options? If we can at least kayak we may be able to salvage the camp experience for ds.

 

--Should we consider getting a wheelchair or little red wagon or something? Those options might be do-able on the shorter hikes that are on camp property. There is one, much longer hike that would be impossible for ds--dh is considering kayaking ds to the end point of the hike to meet up with his group and then kayaking back together.

[Jan in SC]

I would try to see a pediatric orthopaedist immediately. Foot injuries can take a long time to heal. I have nothing against podiatrists, but they usually focus on older people and children can have different issues with injuries. As you know, athletic children don't sit around with injuries, so if after two weeks he is still in pain and hesitant to use it, I would follow up with someone else.

[Perry]

I would try to see a pediatric orthopaedist immediately.

:iagree:

[Harriet Vane]

Clarification--

 

Why an orthopedic dr? Isn't that a bone dr? If the x-ray does not show an hairline fractures or other bone problems, is an ortho the right dr?

 

FWIW this dr assured me he has treated children in the past. When we were there yesterday there was a small child there for an appt. That said, I have no idea how frequently he treats children.

 

Timeline:

 

Two weeks ago Thurs--injury; ice and ibuprofen overnight

 

Fri--saw dr, diagnosis of contusion; ace bandage + total rest for foot + x-ray revealed no bone injury

 

Tues (4 days later)--saw dr again, advised continuing with ace bandage and rest + seeing podiatrist

 

Mon--(6 days later, two days ago)--appt with podiatrist

 

Tuesday (yesterday)--podiatrist read x-ray, felt images were very clear, wrapped ds' foot in soft cast

 

Next Thursday (nine days of soft cast)--podiatrist will re-evaluate

 

We leave for family camp that next Sat.

 

Thanks for your input--I'm going crazy here trying to decide whether to relax and trust the dr or try something else.

[Jan in SC]

If I am reading correctly, the podiatrist read the original x-rays. If so, there could easily be a break in your son's foot. Small breaks take longer to appear on x-ray. They actually show up when the bone begins healing. In a child, it can take even longer to appear.

I am not a doctor, though!! As the mom of three very active and often injured boys, I have heard this over and over.

 

If those are the original x-rays, then I would find a new dr. based on that alone. Maybe one of the doctors on the board will chime in, now!

 

As for why an orthopaedist over a podiatrist...I think a podiatrist is fine for an adult with a foot issue that is minor, or chronic. For an acute injury, or an injury to a child, I am more comfortable with the training an orthopaedist receives. This, for me, would include seeing these injuries on a daily basis.

Obviously, this is my personal opinion!

[Perry]

Clarification--

 

Why an orthopedic dr? Isn't that a bone dr? If the x-ray does not show an hairline fractures or other bone problems, is an ortho the right dr?

Orthopods specialize in the entire musculoskeletal system - so bones, joints, tendons, ligaments, muscles, soft tissues.

 

I would be more comfortable with an orthopod than a podiatrist for an acute injury, especially in a child. You have many good questions- did you ask the podiatrist? I think the answers would depend on how severe the injury is and how quickly he's healing.

 

Here is some very general information about muscle contusions.

[Soph the vet]

I agree with Perry and Jan. Get thee to an orthopedic specialist who deals in feet! Not all hairline fractures or stress fractures will show up on a plain radiograph. An orthopedic doc will also be familiar with all possible ligaments and tendons that can be torn and which actually can be more painful and definitely take longer to heal than a fracture.

Rule of thumb: longer the word, longer the healing takes:

Bone = 2 months

Tendon = 3 months

Ligament = 6 months

 

But I am just a veterinarian, what do I know:lol:.

I have a 9yr. old ds as well and I will be praying yours can still have a good time at family camp!

Soph

[Jann in TX]

They have been more painful than a break--and have taken longer to heal.

 

If you take 'natural' products have your son take a few Arnica tabs every day... this will speed up healing... Arnica gel applied 2 times a day on the injury will also help (AMA recognizes this product and studies have shown that it works!). Our local grocery has it in the health care isle.

 

Talk to your Podiatrist about your trip plans. I'd also ask for a soft boot-type cast instead of the wrap. It may be possible to get him an inexpensive one from the drug store to keep his foot immobile while he swims/boats at family camp.

 

I'd go for either the wagon or a wheel chair depending on the terrain (wheel chair in rougher terrain). Crutches are a BUMMER cross country!

 

An MRI would not speed up healing--and it may not be able to tell the exact extent of the injury.

 

A second opinion could not hurt--and I'd go with a pediatric orthopedic Dr (foot specialist if possible) even though I LOVE my Podiatrist.

 

It is a bummer your son will have to learn a life lesson and he will probably miss out on some possible fun at family camp... but I bet there will still be plenty of memories he can make--with a good attitude!

[DianeW88]

As the mom of a ballet dancer and a ped nurse, I have ample experience with foot injuries. Unfortunately. :glare:

 

A nasty bruise can last for more than six weeks, so I wouldn't be overly concerned just yet, and I wouldn't push for an MRI. My dd has had more foot injuries than I can count and has never undergone an MRI for any of them. Even when a stress fracture was suspected, the orthopedist suggested just waiting.....turned out he was right. Inflamed tendon, not a stress fracture. In fact, as a pp said, soft tissue injuries are the worst and much more painful than an actual fracture. Just continue to treat the symptoms for now. If you feel a consultation with an orthopedic surgeon is necessary, then I would pursue it, but I'm not sure how much differently he would treat the injury.

 

Of course, I've haven't seen your son's injury in person, so this is all speculation, but from your description and the other doctor's recommendations.....I would give it more time.

 

Diane W.

married for 22 years

homeschooling 3 kiddos for 16 years