DEFINITION--A collection of pooled blood within constricted space on the top of the foot (dorsum) or bottom of the foot (plantar area).
BODY PARTS INVOLVED
Dorsum or plantar area.
Soft tissue surrounding the hematoma, including nerves, tendons, ligaments, muscles and blood vessels.
SIGNS & SYMPTOMS
Swelling over the injured area.
Fluctuance (feeling of tenseness to the touch, like pushing on an overinflated balloon).
Redness that progresses through several color changes--purple, green-yellow, yellow--before it completely heals.
CAUSESDirect injury, usually from a blunt object or from landing on a hard surface. Bleeding into tissues then causes the surrounding tissue to be pushed away.
RISK INCREASES WITH
Contact sports, 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, well-designed shoes during competition or other athletic activity to decrease the risk of foot injury.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care unless the hematoma is very small.
Needle aspiration of blood from the hematoma, if the hematoma is accessible. At the same time hyaluronidase (an enzyme) can be injected into the hematoma space. Hyaluronidase hastens absorption of the blood.
Self-care for minor hematomas, or following serious hematomas during the rehabilitation phase.
Physical therapy following serious hematomas.
Your own observation of symptoms.
Physical exam and medical history by a doctor for all except minor injuries.
X-rays of the injured area to assess total injury to the foot and to rule out the possibility of an underlying bone fracture. Total extent of the injury may not be apparent for 48 to 72 hours.
Infection introduced through a break in the skin at the time of injury or during aspiration of the hematoma.
Prolonged healing time if activity is resumed too soon.
Calcification of the blood remaining in the hematoma if the blood is not completely removed or absorbed.
PROBABLE OUTCOMEAverage healing time is 2 weeks to 2 months unless the blood is removed with aspiration. Healing time is much less with this treatment.
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.
Continue ice massage 3 or 4 times a day for 15 minutes at a time. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use hot baths, showers, compresses, heat lamps, heating pads, heat ointments and liniments, or whirlpools.
Don't massage the foot. You may trigger bleeding again.
For minor discomfort, you may use:
Non-prescription medicines such as acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe stronger medicine for pain, if needed.
ACTIVITYBegin activities slowly and stop exercise as soon as pain begins. Increase activity as healing progresses. To prevent a delay in healing, protect the hematoma area against excessive motion soon after injury. Motion breaks down the clot and causes irritation throughout the foot, leading to possible scar formation, calcification and restricted movement after healing.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
Begin daily rehabilitation exercises when supportive wrapping is no longer needed. Use gentle ice massage for 10 minutes prior to exercise.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of a foot hematoma that doesn't begin to 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.