repeat injured foot

It looks like you never read my first e-mail where I am giving the history of my case I am sending it again. Please read on Four months ago I injured the front part of my right foot practicing martial art. My sparring opponent landed from a jump directly onto my extended foot. Unfortunately all this happened while I was traveling in Brazil, AND I had no immediate access to medical care. I was supposed to catch a flight back home the next day, so I bore the pain AND made it to the airport. By this time my foot (especially the first couple of toes AND the place where they join the foot) was very swollen AND was becoming a dark blue. I managed to walk by using only the heel of the right foot, AND this was incredible painful as well. A doctor at the airport prescribed some anti-inflammatory pills for me, which I took. At home, I took some x-rays AND a doctor at my university looked at them AND determined nothing is broken AND that I had probably bruised my foot very badly, AND must wait for it to heal. When it did not improve after three weeks (by which time the swelling had almost disappeared but the pain remained) she gave me a referral to see an orthopedic surgeon. The orthopedic surgeon, after taking more x-rays AND finding nothing broken OR fractured, concluded that the metatarsal-phalangeal joint of the second toe of my right foot is unstable, AND gave me a brace to wear for two weeks. When those two weeks passed with no great improvement, he diagnosed a chronically unstable joint, AND recommended prolotherapy. So far I had had three injections, spaced two weeks apart. I have felt no improvement. The last injection was extremely painful, it felt as if the needle touched a raw nerve, AND my foot has been more painful since then. I have also discovered that the big toe of my right foot cannot bend, AND when I try to bend it with my hands it is very painful. When I brought this to the attention of the doctor administering the prolotherapy he recommended I get a bone scan to check for stress fractures. I had the bone scan. No doctor has seen it yet, so I don’t have a report, but I can see for myself when I look at the slide that the two toes are lit up. I know stress fractures are caused by an increase in the amount OR intensity of an activity, AND not so much by trauma. It is true that I had an increase in training intensity prior to this injury, but I had no pain OR discomfort during the training. Could this be a “regular” fracture that just didn’t show up on the initial x-rays? Could the late diagnosis of the fractures have caused any damage? Are there any other tests for any other kind of injury resulting from trauma to the foot that I should undergo before deciding how to treat the known problems (unstable joint AND possible fractures)? How about an MRI? What would surgery imply, if I had to have it to treat these problems? I have been rather discouraged by the lackadaisical air with which these doctors have treated my injury, AND I would like to be more proactive about finding a fitting treatment AND healing my foot. I am very afraid that this will remain a chronic condition, especially since so much time has already passed. I would appreciate any insights! Thanks, .Adi in New Yo

אדי שלום. כבר קראתי את כל הסיפור שלך בעבר. אין לי מה להוסיף על מה שכבר כתבתי. זה מקרה מורכב שלא ניתן לטפל בו דרך המחשב. אני ממליץ לך שוב לפנות לאורתופד נורמלי ולא לרופא ההזרקות שלך... בברכה - דר' טיטיון.