Hi all, I'm looking to get some advice on my symptoms, treatment and possible recovery time (if at all ).

6.5 months ago I dropped an 80lb dumbell directly onto my pinky toe. To be honest I didn't think much of it initially, I figured it was bruised and the swelling would come down - I had some pain, but not much - so I continue my activities of walking etc.

About a month later, the swelling had not gone down. I got some xrays and had a fracture across my mid-phalanx, so I buddy taped it and tried to stay off it. Unfortunately 3 months after the initial injury it was still swelling - I reinjured it by knocking it off something and the next day it was completely black and blue like day 1. I went to a podiatrist, for more x-rays and was just told to give it more time.

Then, about 2 months later I went to see a different podiatrist as the symptoms were persisting, although the swelling had gone down a bit.

He diagnosed me with neuropathy and advised me to contrast bath twice a day (I also had some blood pooling across the foot). I also wore compression socks for a while, and wrapped the toe with Copan tape.

Here are my symptoms:
- I have my ups and downs but it's usually swollen. For a few days last week I thought it was better because I had 2 days in a row where the redness and swelling decreased a lot.

- Walking a lot, hot showers, and just general heat aggravates it a lot. It just goes bright red after a hot shower, and proceeds to swell up with burning and itching. It's as if the sheath is thin or damaged, but I'm not sure.

- Icing helps, and cold weather seems to stop extreme swelling. I also keep it wrapped with Copan tape, which helps a lot. I guess I'm lucky that I can just compress it to keep swelling down but I worry that restricting blood flow might be worse for it.

Anyone have any ideas, suggestions, help? The problem is I guess the swelling could be down to soft tissue trauma from the crushing, but the sign of sensory neuropathy are there for sure.

I thought I would attach a picture of the area after a hot shower to show what I'm describing (the swelling is pretty low today):

That photo looked so familiar!--except that it's my fourth and fifth toes that turn bright red (and swollen), while the first three toes are more blue-purple. I didn't have a similar episode of heavy trauma, but my PN started with major swelling of the foot and leg, eventually spreading to other foot and leg.
(Tested for circulatory issues; none. Took med for Raynaud's; no effect. Advised to wear light compression stocking despite no circ issues, but that made the pain worse.) So I have no help to offer you -- just some additional sympathy, along with the observation that the symptoms might come from something other than blunt trauma. Good luck. (By the way, almost all of my shoes irritate my toes now, despite no perceptible change in shoe size.)

Is that toe only red like that after a hot shower?

Is is red all day long? Is it swollen when you first get up or only after you have walked around?

It only really get that bright red after a hot shower. Some days when I wake up its a normal color, and swelling is low especially after wearing the tape.

I had a couple of days last week where it was pretty normal and didn't even need to wrap the rape on one day and slept without it. Then is seemed to get a bit worse again for no reason and it's a little red and swollen most of the time.

Over the months, on average, I think it's come down a bit. It doesn't immediately balloon up after the shower anymore but just goes bright red. It's definitely inconsistent. I slept without the tape 3 nights ago and it was swelling without the red color (felt hard to touch), standing up immediately softened it. Weird.

If I walk for more than a few minutes (I'm still cautious while walking because it starts to hurt - maybe some soft tissue damage) it can swell up more and burn and itch. Alcohol seems to exacerbate this too.

Yes, alcohol would dilate the superficial capillaries and increase blood flow.

You know what you can try? Salonpas patches. The original type with methyl salicylate in them.

http://www.salonpas.us/product/salonpas-original/

I'd put a whole patch 1/2 over the edge of your foot where that toe is. Fold it so 1/2 is on the top of your foot and the other half goes over the side to the bottom. Place it so the top edge is as close to that pinky as possible. The anti-inflammatory actions will
seep into the area and give some relief perhaps. I use them on my feet all the time. I have broken sesamoid bones and arthritis.
(in addition to PN).

Another inexpensive remedy is Morton Epsom Lotion. This improves circulation to the periphery, so that the blood flow is more normal. Rub into the toe and top of the foot. Use only a small amount, as a little goes a long way. Inflammation closes off circulation, and by opening up the blood vessels, then the blood can do its job better. You may be having spells of constriction followed by dilation (which is the red part)

That red toe resembles what happens when you get cold shock, and then warm up, and the blood vessels dilate and turn things red. Ears for example exposed to cold turn red that way.

Morton's is at WalMart and Walgreen's locally. And online at Amazon.

http://www.mortonsalt.com/for-your-h...-epsom-lotion/

Thanks for much for the response!

So, are my capillaries malfunctioning? Most people seem to have issues with cold, rather than heat but nerve damage just means the nerves react the wrong way right in any direction?

I think the reason my toe stayed normal for a whole day with proper skin tone and minimal swelling is because I kept it really cool the whole time, and only had mild showers to stop the trigger. Do you think I should avoid contrast baths at this stage? Sometimes when I wake up and take off the tape, the skin switches to normal skin color, and then the baths make it go red and swell a bit again - not sure if I'm better off doing the baths to keep the blood flow higher, or just work to minimize the swelling - maybe it's a catch22!

I actually ordered some Epsom IT lotion yesterday on your recommendation so thanks for that - I'll give it a try. Sometimes, it can feel raw, red, itchy and hopefully the cream helps with that.

Honestly, I don't experience much pain with it when I keep it cool and don't walk too much. In fact, I never had bad pain which is strange - and I'm guessing this was because I destroyed the nerves. I still cycle 6 miles a day without pain (some niggling, tingling) but even that has subsided a bit - it probably is because it's freezing cold outside

Do you think those patches could help if I wanted to go out for a few drinks, because I know it will flare up and burn?

The patches are for inflammation. When you injure tissue, that releases cytokines (inflammation chemicals)...which in the short run work well, but in the long run can keep inflammation working when it is no longer needed.

By turning off these chemicals with the Salonpas, then inflammation goes down, redness goes down, and pain goes down.

The Morton's or your Epsom IT is more for circulation. If your skin is really broken or irritated, the magnesium lotions may sting.
Use them then, slightly away from the toe skin, more toward the top of the foot area.

There is fascia in the foot, tendons, besides the bones, and any or all of them could have been injured. If you feel pain, your nerves are not dead, but just reacting to it all.

Using topical things on the foot, should be tried first, rather than drugs. Sometimes these topicals are better than oral things because they fix the blood flow which may be messed up and not let things in the blood to heal thru to the toe damage.

Ice always feels better on an injury. And also nerve injuries like ice better than heat. You can try ice packs on your foot 2 or 3 times a day and see if that speeds things along too. Since cold feels better, try that. Don't over do, and max of 20 minutes at a time.

Interesting, so I might still have repairing soft tissue damage and the neuropathy is just a manifestation of that? i.e. it might not just be chronic neuropathy at this stage - I guess it's too early to tell.

I know the bone didn't union properly either at the time - it's an awkward spot to immobilize.

My podiatrist recommended Neuro-Eze, but I could only find it online and my instinct tells me it's a bit of a scam but I could be wrong - it is supposed to improve oxygen using L-Arginine but I don't even know if that is permeable through skin.

I will probably continue to ice it. It definitely give some relief when it swells or burns. Do you think I should just leave out the heat bath then? And should I ice it even if it's not swollen when I wake up?

I'd only ice it if it hurts.

Are you really tall? I suspect from your photos that you are. If so it is a LONG way to that pinkey!

Arginine is in some diabetic foot creams to increase circulation.

The Magnesium lotions do the same thing. So I'd start there. Magnesium also blocks the NMDA pain receptors, so it is more useful than arginine.

You could combine the heat treatments followed by ice... see how that goes. Don't over use cold though, as that constricts blood flow.

Think about how your hands feel in the snow without gloves. Then you come in and warm them up.... and they get red and tingle and burn! Same thing with that pinkey. If it hurts at bedtime do the cold treatment then. You will not be standing up and the blood flow with return to normal quickly, when you are sleeping.

Injuries can take a while to heal. Give it time. Don't worry about neuropathy at this point. You just have a trauma toe.
I'd take some vit C daily.... 500mg for about 2 months. Also so other antioxidants, if you want. Some people develop RSD from injuries or surgery or trauma to the ankles/feet and wrists. Vit C seems to block this potential. Since you are taking a while to heal you will want to prevent RSD.

RSD patients however do hate cold treatments, and prefer heat, so you are still the reverse of that. RSD may become permanent, but studies in Europe show Vit C prevent that for many patients.

Keep your foot elevated when you can, at home, etc. I had a surgery on my foot when I was 12, on the instep and it took over a year to heal. Foot injuries take time.