Orris

a 23 yr old man slipped from stairs and had a >2cm swelling

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Need a bit more detail to guide this safely.
  • Where is the swelling? (head, ankle, knee, wrist, etc.)
  • Is it painful, and can he move/use that part?
  • Any red flags: severe pain, deformity, inability to bear weight, vomiting, fainting, confusion, severe headache, bleeding, vision changes?
If this is a fresh injury with a swelling >2 cm, basic first aid now:
  1. Rest the area
  2. Ice 15–20 min every 2–3 hours
  3. Compression bandage (not too tight)
  4. Elevation above heart level
  5. Avoid massage/heat for first 24–48 hours
He should get examined today if swelling is large, pain is significant, or movement is limited, to rule out fracture/ligament injury.
If head injury symptoms are present, go to emergency care immediately.

And has a swelling at Middle to lateral aspect of foot with little tenderness and pain on walking

Medical Text Search

foot injury lateral midfoot swelling tenderness Ottawa foot rules fracture

Medical Text Search

5th metatarsal fracture Jones fracture avulsion fracture lateral foot

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GradeResponse
This sounds like a lateral foot injury, possibly:
  • soft tissue sprain/contusion, or
  • base of 5th metatarsal fracture (common after twisting fall).
Because he has pain on walking + swelling, he should get an X-ray foot to rule out fracture.
Use the Ottawa foot rule: X-ray is needed if there is midfoot pain plus either:
  1. tenderness at base of 5th metatarsal, or
  2. tenderness at navicular, or
  3. inability to bear weight for 4 steps
    (Bailey & Love, 28e, p. 527).

What to do now

  1. RICE: rest, ice, compression, elevation for first 24-48 h.
  2. Avoid running/walking long distances.
  3. Use pain medicine like paracetamol (if no contraindication).
  4. Get examined today in clinic/ER for foot exam and X-ray.

Go to emergency urgently if

  • cannot bear weight at all
  • deformity, rapidly increasing swelling, severe pain
  • numb/cold toes
  • open wound, fever, or worsening pain despite rest.
If you want, I can help you do a quick self-check (exact tender points) to decide how urgent the X-ray is.

Treatment

Medical Text Search

lateral midfoot fracture 5th metatarsal treatment conservative management

Medical Text Search

foot sprain fracture RICE immobilization weight bearing rehabilitation

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GradeResponse
Treatment plan (for this foot injury):
  1. Immobilize + protect
    • Keep weight off the injured foot as much as possible.
    • Use a crepe bandage / ankle-foot support.
    • Prefer a walking boot or below-knee splint/cast until X-ray result if pain on walking is significant.
  2. RICE for first 48 hours
    • Rest
    • Ice 15 to 20 min every 2 to 3 hours
    • Compression (not too tight)
    • Elevation above heart level
  3. Pain control
    • Paracetamol for pain.
    • If needed and no kidney/gastric/asthma contraindication: ibuprofen-type NSAID after food.
  4. X-ray foot (AP/oblique/lateral) today
    • Important to rule out 5th metatarsal fracture or midfoot (Lisfranc) injury.
    • Midfoot injuries can have morbidity if missed; suspected cases may need CT (Bailey & Love, p. 459).
  5. After imaging
    • If sprain/no fracture: continue support, gradual weight-bearing over days, physiotherapy/ankle-foot exercises.
    • If fracture present: ortho plan (cast/boot vs surgery depending on type/displacement).

Urgent red flags (go ER now)

  • Unable to take 4 steps
  • Increasing swelling/severe pain
  • Deformity
  • Numbness/cold toes
  • Skin color change/open wound
If you want, I can give you a day-by-day home care schedule for the next 7 days and when to start walking.
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