DEFINITION--Bruising of the skin and underlying tissues of the foot caused by a direct blow. Contusions cause bleeding from ruptured small capillaries that allow blood to infiltrate muscles, tendons or other soft tissue.
BODY PARTS INVOLVEDFoot tissues, including blood vessels, muscle, tendons, nerves, covering to bone (periosteum) and connective tissue.
SIGNS & SYMPTOMS
Local swelling--either superficial or deep.
Pain and tenderness over the injury.
Feeling of firmness when pressure is exerted at the injury site.
Discoloration under the skin, beginning with redness and progressing to the characteristic "black and blue" bruise.
Restricted foot activity proportional to the extent of injury.
Direct blow to the foot, usually from a blunt object.
Wearing a shoe that has faulty cleats or spikes or wearing a wrinkled sock. This will cause a "stone bruise."
RISK INCREASES WITH
Contact sports such as football, basketball or baseball, especially if the foot is not adequately protected.
Medical history of any bleeding disorder such as hemophilia.
Poor nutrition, including vitamin deficiency.
Use of anticoagulants or aspirin.
HOW TO PREVENTWear appropriate protective footgear during competition or other athletic activity.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Injections with long-acting local anesthetics and corticosteroids, unless the injury is quite small.
Self-care for minor contusions, or for serious contusions during rehabilitation.
Physical therapy for serious contusions.
Your own observation of symptoms.
Medical history and physical exam by a doctor for all except minor injuries.
X-rays of the foot and ankle to assess total injury to soft tissue and to rule out the possibility of underlying fractures. The total extent of injury may not be apparent for 48 to 72 hours.
Excessive bleeding leading to disability. Infiltrative-type bleeding can (rarely) lead to calcification and impaired function of injured muscle.
Prolonged healing time if usual activities are resumed too soon.
Infection if skin over the contusion is broken.
PROBABLE OUTCOMEHealing time varies with the extent of injury, but average healing time for foot contusions is 1 to 2 weeks.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
Wrap an elasticized bandage over a sponge- rubber pad on the injured area. Keep the area compressed for about 72 hours.
Continue ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage gently over the injured area in a circle about the size of a softball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, heat liniments or ointments, or whirlpool treatments.
Massage gently and often to provide comfort and decrease swelling.
For minor discomfort, you may use:
Acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe stronger medicine for pain.
ACTIVITYBegin activities slowly and stop exercise as soon as pain begins. Increase activity as healing progresses.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Your doctor may prescribe vitamin and mineral supplements to promote healing.
Begin daily rehabilitation exercises when supportive wrapping is no longer needed.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have a foot contusion that doesn't improve in 1 or 2 days.
Skin is broken and signs of infection (drainage, increasing pain, fever, headache, muscle aches, dizziness or a general ill feeling) occur.