Ask a doctor on the topic of Orthopedics

Toes contusion with swollen foot that turns red to blue when standing.

February 11, 2017 | 25,00 EUR | answered by Dr. med. Ive Dr. Schaaf

Dear expert,

10 days ago, I bumped the third toe on my right foot head-on. This was followed by a brief, intense pain, and by evening the toe was severely swollen and black from the middle joint upwards, with a noticeable bump. On the tip of the toe, there was a tiny red/black spot (blood blister?) - which is still visible today, with a slight bluish discoloration under the toenail.

I initially thought it might be a fracture, so I buddy-taped the toe to the second toe without following the RICE rule.

The next day, I had a contact allergy (presumably) to a skin cream (benzoyl peroxide 10%), which worsened and spread over the weekend (cheeks, nose, neck), but is now almost gone thanks to topical cream.

Over the weekend, the toe pain was disproportionately severe and difficult to localize, more like in the entire foot.

The following Wednesday (1 week after the incident), I went to the emergency room for an X-ray:
"S90.3 Contusion of other and unspecified parts of the foot. Cold compresses and rest."

These are the symptoms still present this weekend:
- Toes (except big toe) practically immobile
- Foot swollen in many areas (under toes, top of foot, side of small toe)
- but no visible bruising on the skin (it disappeared after a few days)

I am not moving the foot, keeping it elevated and cooled. I am still using quark compresses and taking ibuprofen.

It is either red and hot or cold and red/blue.

I do notice some improvement, however.

What concerns me:
When I stand upright, the foot and toenails turn red after a few minutes, then more blue, and I feel pressure.
When I elevate the foot, the pressure goes away.

Is this normal?

On Monday, I have to give a presentation and will have to be on my feet for a few hours. Assuming the condition remains the same, is there a risk if the foot stays "blue" for an extended period?

How should I proceed?

Thank you.

Dr. med. Ive Dr. Schaaf

Hello,
The course of events does not sound normal.
Unfortunately, there is a possibility that you may develop Complex Regional Pain Syndrome (CRPS) or Morbus Sudeck (the older term).
You should present yourself again in the clinic with this exact question.
Alternatively, you can also consult an orthopedist. Clarifying the question mentioned above is important and should be done as soon as possible.

If CRPS can be ruled out, then it is just an excessively strong and long-lasting swelling. It is annoying, but harmless.
If the presentation is important tomorrow, go ahead with it, but if possible, wear compression stockings or at least a well-fitting lace-up boot so that the leg does not swell.
Severe swelling prevents oxygen exchange in the tissue and leads to pain that eventually becomes unbearable. To avoid this - and be able to give the presentation - compression would be the appropriate measure, whether through a stocking or shoe.

All the best and get well soon.

Dr. Schaaf