Orris

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

Reading File
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

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foot injury lateral midfoot swelling tenderness Ottawa foot rules fracture

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5th metatarsal fracture Jones fracture avulsion fracture lateral foot

GradeResponse
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

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lateral midfoot fracture 5th metatarsal treatment conservative management

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foot sprain fracture RICE immobilization weight bearing rehabilitation

GradeResponse
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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