Potential Injuries and Treatment Options for Dropping Heavy Objects on the Top of the Foot
Radiographic evaluation is indicated for acute foot trauma with point tenderness over the malleoli, talus, or calcaneus, and should include anteroposterior, lateral, and mortise views to assess for fractures. 1
Types of Injuries
Bony Injuries
- Fractures of the metatarsals are common when heavy objects are dropped on the top of the foot 1
- Fractures of the talus or navicular bones may occur with significant impact to the dorsum of the foot 1
- Calcaneal fractures may result from high-energy trauma and require axial Harris-Beath views for proper evaluation 1
- Children under 6 years are more prone to bony injury with 48% of injuries resulting in fractures or dislocations 1
Soft Tissue Injuries
- Contusions and hematomas are common with blunt trauma to the dorsum of the foot 1
- Tendon injuries, particularly to the extensor tendons, can occur with direct trauma 1
- Ligamentous injuries may accompany fractures, especially with high-energy trauma 1
- Severe crush injuries can lead to compartment syndrome requiring urgent evaluation 2
Neurological Injuries
- Peroneal nerve injury can occur with trauma to the dorsum of the foot, potentially leading to foot drop 3, 4
- Foot drop presents as inability to dorsiflex the foot and can significantly impact mobility and increase fall risk 5
Diagnostic Approach
Initial Assessment
- Apply Ottawa Foot Rules to determine need for radiography: point tenderness over navicular, base of fifth metatarsal, or inability to bear weight 1
- Radiographs are indicated with positive Ottawa Rules with 99% sensitivity for detecting foot fractures 1
- Standard three-view radiographs (anteroposterior, lateral, and mortise) should be obtained initially 1
Advanced Imaging
- CT is recommended for suspected complex fractures or when radiographs are negative but clinical suspicion remains high 1
- MRI is the most sensitive modality for detecting occult fractures and soft tissue injuries when radiographs are negative 1
- Ultrasound may be useful for evaluating soft tissue injuries and identifying non-radiopaque foreign bodies with 90% sensitivity 1
Treatment Options
Immediate Management
- PRICE protocol (Protection, Rest, Ice, Compression, Elevation) is recommended for acute foot injuries 1
- Ice application helps reduce edema, decrease pain, and potentially shorten recovery time 1
- NSAIDs can improve pain control, decrease swelling, and allow for more rapid return to activity 1
Conservative Treatment
- Functional rehabilitation is preferred over immobilization for most foot injuries 1
- Semirigid or lace-up supports are superior to elastic bandages for ankle and foot injuries 1
- Weight-bearing status should be determined based on injury severity and stability 1
- Physical therapy focusing on range of motion, strengthening exercises, and proprioceptive training is beneficial for recovery 2
Surgical Management
- Displaced fractures, open fractures, or unstable injuries may require surgical intervention 1
- Compartment syndrome requires emergency fasciotomy to prevent permanent tissue damage 2
- For persistent foot drop, surgical options include nerve decompression, repair, or tendon transfers 5
Follow-up Care
- Reexamination 3-5 days after injury is important when swelling has decreased to better assess injury severity 1
- Progressive weight-bearing and rehabilitation should be initiated as tolerated 1
- For severe injuries, support devices may provide protection against future injuries, particularly in those with a history of recurrent injuries 1
Special Considerations
- Crush injuries to the foot require more aggressive management and often multidisciplinary care involving orthopedic surgeons, physical therapists, and potentially vascular specialists 2
- Persistent pain or functional limitations after appropriate treatment warrant further evaluation for occult injuries 1
- Foot drop requires specialized management including ankle-foot orthoses and possibly surgical intervention if it persists 6, 5