How to determine if an injury on the top of the foot is a soft tissue injury or a fracture

　　For a sprained instep, you can determine whether it is a soft tissue injury or a fracture by observing for deformity, checking tender points upon palpation, testing the degree of restricted movement, examining swelling and bruising, and assessing weight-bearing ability. If signs suggestive of fracture appear or symptoms worsen, prompt medical evaluation with imaging is recommended.

　　1. Observe for deformity: Soft tissue injuries do not involve changes in bone shape, so the instep maintains its normal contour; fractures may present with visible deformity, protrusions, abnormal indentations, or unnatural angles at the injured site.

　　2. Check tender points upon palpation: Soft tissue injuries usually cause diffuse pain without a clearly localized tender spot; fractures often have a specific, intense point of tenderness, with severe pain on pressure and possibly a sensation of bone grinding.

　　3. Test the degree of restricted movement: With soft tissue injuries, slight movement of the instep is possible, although pain increases during motion; following a fracture, voluntary movement of the instep is impossible, and passive movement causes severe pain or even abnormal motion.

　　4. Examine swelling and bruising: In soft tissue injuries, swelling and bruising develop gradually and are relatively mild; in fractures, swelling occurs rapidly after injury, and bruising is extensive, deep-colored, and may spread to the ankle or toes.

　　5. Assess weight-bearing ability: Patients with soft tissue injuries may勉强 stand or walk slowly, though pain increases with weight-bearing; patients with fractures cannot bear weight, experiencing severe pain when attempting to stand or walk, and may be unable to support their body.

　　After a sprain, immediately stop any activity to prevent further injury. Apply cold compresses within the first 48 hours to reduce swelling and pain, followed by appropriate heat application to promote circulation afterward. Elevate the affected limb above heart level and avoid pressing or massaging the injured area.