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Foot & Ankle Problems Message Board


Foot & Ankle Problems Board Index


Hello,
I wanted to put together my story of lisfranc joint injury in one post and keep it updated as I go along.
The lisfranc injury requires a very long recovery period, through out this time I had learned a lot, through the internet, this web site, books, doctors and friends. I wanted to share my story and what I have learned.
If you search for my handle you will find a number of posts, but most of them only show a part of the story.


Each lisfranc's injury is different, the treatment plan can vary widely based on each individual doctors take on, what is still a controversial, procedure for a rare injury.

Things to consider when looking at my treatment plan, I was active in sports, I have injured my foot windsurfing, during winter months I used to teach snowboarding. I was looking for a doctor with experience in treating athletes with a similar injury. I needed my foot back in working order to get back to teaching sports. I was told that screws have to come out or there is a good chance I am going to break them during one of the snowboarding jumps. I was also given an option to get a mini tightrope. This is a new device on the lisfranc's market, available since last year (2007) that supposed to prevent re-injury, there is not enough data on the effectiveness of the device as of yet.
If you have a ligamentis lisfrancs (your ligaments are torn) they will not grow back, the way your body fixes itself is with scar tissue. I used BioSil to speed up scar tissue generation, do not know how effective it has been, but my nails grow 3 times as fast :)

Here is my story:

5/31/2008
I was windsurfing on a small lake in Wisconsin, with my feet in straps. I have been windsurfing for 15 years and the day was pretty relaxing with flat water and light gusts. I was racing with my friend and when another gust rolled through I felt very sharp pain in my ankle. It was almost like I had a nail driven through my foot, considering there were nail in the water I figured I might have pinched a nerve and kept on going for another 10 feet. The pain was not going away, it was getting more intense if anything. I let the rig go and fell into the water, the pain was getting to unbearable levels, I suspended my injured foot into the water and waved for help. I felt my foot swelling up and decided to remove the windsurfing booty before the foot is too large and while it is numb from the cold water. That was a good decision. With the foot out and me eventually out of the water I was picked up by my wife. She also had a large beg of ice ready for me, I was able to freeze my foot to a completely numb state and with the help of some alive the pain was subdued to a manageable level.
I waited a day before showing up at the doctors office.
The pain was no longer intense, yet the foot was very swollen, the ankle was looking ok, but the foot - was twice the size and blue was showing on top and bottom of my foot, I have not seen an injury like that before. At this point I had a slight inkling that I might need to see a doctor, this one did not look like something I can just walk off.

Lessons learned:
lisfranc joint damage is a suspect when your foot swells up and blue shows up on the bottom of the foot.
Jumping on one foot to get around is dangerous, get crutches asap


6/2
I went to see a doctor (OS) at Bannokburn office, he took a number of x-rays, a couple of them were load bearing (painful), the diagnosis was that I had a lisfranc sprain with no dislocation and a couple of bone chips. Conservative treatment plan was recommended, meaning - I stay in a hard cast for 8 weeks. At this appointment a fracture I had sustained in my ankle was missed. I was put in a dark blue cast and sent home with a pair of crutches. I was told to show up in 2 weeks for a check up.

Lessons learned:
with foot injuries get a second opinion, always
although it is tempting to think that surgery can be avoided for lisfranc injuries, it is better to face the reality as soon as possible. There are countries in the world that do not do open reductions for lisfranc dislocations, but use different fixation techniques, like setting the bones manually under x-ray and securing them in place with external application of a cast, that gets re-applied when swelling gets down (every 2-3 days). Unfortunately this approach as a low success ratio.
If you are going with a surgery, know that your future walking ability depends on how soon you get the surgery done, post-traumatic arthritis sets in quicker if you wait longer.


6/16
I am back from a follow up, the cast is taken off. By then the swelling is way down and foot is only about 1.5 times the size of the other, blue spots are around toes, but it looks like I am on my way to a speedy recovery. Minimal pain, mostly located around my ankle (remember that missed fracture?), the foot hurts little under pressure exerted during examination. More x-rays are taken, weight bearing x-ray shows separation of 2mm.
I am being asked if I stepped on my foot at all since the cast was put on, I say of course not, as a matter of fact I kept it up all the time to help with the swelling. I was told to wiggle my toes to speed up healing and that was the only thing I did.
I asked about the pain in the ankle, another set of x-rays later I was told I have fractured a bone in my ankle as well.
I am being told that I will need a surgery to fix the lisfranc, my dreams of speedy recovery are crushed, I call on my friends and relatives to find a doctor who would have a different take on the injury, I hope to avoid the surgical intervention at any cost.
I solicit second opinions from as many doctors I can, but getting appointments on such a short notice is almost impossible and the doctors I do get to talk to all tell me that this is very tricky procedure and they do not have enough experience with it to do it well.
In mean while I learn that the sooner I get the surgery the better my chances are going to be. The doctors offering non-surgical treatment give me no guarantees about the results of the treatment, that is not encouraging.
By the time the end of the week rolls around I am totally exhausted, my pregnant wife and my parents are falling of their feet after running from one doc's office to another. My hands are shaky my sides are bruised from crutches. Finally we talk to a doctor who tells us that he has done plenty of the lisfranc surgeries and can do mine as well. But his schedule is booked for next 3 month.
We get on a waiting list.
The x-rays at this appointment showed separation of more than 7mm, looking at my bones floating around my foot cleared any doubts I had about fixing this surgically.

Lessons learned:
If you are diagnosed or suspect lisfranc injury, seek second opinion and just in case get on the surgery list, if you decide not to pursue surgery, you can always cancel the appointment.
If the foot does not hurt much, it does not mean you will be able to walk on it.


6/20
I am called in for a surgery, they had an opening, the only minus the hospital is out-of-network for my insurance. I went for it any way.
I was exhausted, hurting and tired, stressed out of my mind coming in to the hospital. The first IV I got was to calm me down, from there on I just did not care, the drug induced Haze surrounded the procedure. I was given a block followed by general anesthesia.
The last thing I remember was inhaling the gas and when I exhaled I was back in the waiting area. Given 2 vicaden and told to start taking painkillers regularly. And so I did, double dose of Norco 2 hours later, the pain hit about 3 hours post surgery, it was brutal, with anything to take my mind off the pain and counting minutes to the next does of norco, it was hell. The minutes crawled the pain was unbearable, at some point I started talking about going to hospital to get pain control going. But I managed to live through it. More Norco and more. It is hard to remember everything that happened, I had my parents keep watch over me changing ice every half hour on my foot to keep swelling down day and night. Everyone was beat down in three days following the surgery. Even when the pain is under control getting a normal sleep is hard, keeping the foot elevated 24 hours a day is tough on your back and uncomfortable to sleep. But keeping foot up, higher then you heart level, will reduce swelling and assists healing.

Lessons learned:
start Painkillers asap
getting off the painkillers will be an adventure, arrange a weaker prescription ahead of time to get you off the strong stuff
have your relatives and friends lined up, you will need a lot of help
think ahead about getting to the bathroom, it will not be simple, you might want to get a porta-poty and pee-cup ahead of time.
pain eventually goes away, although it does feel like you just pass out from it. Be tough, it will be over.
Have food prepared and stored ahead of time, recover after the surgery can take a long time.


7/18
I am back at the doc's office, the hard cast is taken off and replaced with a walking boot, but no walking is allowed.
In the month preceding this welcomed change, I was in bed, with my foot up. Pain was managed with norco and later with darvocet, pretty successfully over all. I could only get 2 hour long periods of sleep through out this time, turning was a wake up and do it process. My physical condition has deteriorated, the affected leg became a match stick, my overall muscle tone was very low, I lost a lot of strength a lot more the I thought is possible.
I had hard time rolling out of the bed and making it to the bathroom. Each step was a full blown adventure. I could not keep my foot down for more then 5 seconds! make it 2 seconds, I was training it to stay down every day, so the 5 second down was an achievement. I also tried to move my injured foot to keep the muscles alive, but just did not have the strength to do enough of the exercises to make a visible difference.
Please keep in mind that I planned on exercising my upper body and even wrote out the exercises for my abs and legs to do post-op, I developed a list based on the movement restriction (having one leg raised at all times and no sharp movements), but very little reps could be done.
Instead of the exercise I used a device called air-o-sage, a as seen on TV product, that is past its fame, it is composed of inflatable cuffs that you can put on your legs, cuffs inflate to apply gentle pressure and help with circulation.
Using this device made a considerable difference in my healthy leg.

Here is the exercises I planed to do:
(while on my back)
abs crunches (keep my legs up and lift upper body)
with my back on the bed, straight leg lifts
followed by bicycle with my legs while on my back
then
flip slowly on to my stomach and do the leg lifts one at a time to work the hamstrings and butt.
finish the routine off with push ups (keep your legs bent at the knees with feet up).

Lessons learned:
air-massage works
get of the painkillers asap, addiction sets in fast
you will get weak, very weak, be ready.
eat well, eat fiber
exercise as much as you can
if it is painful to keep your foot down for more then a couple of seconds, you can train the foot by lowering it for short period of a time.
keep the foot up ALL of the time (unless you are training)
watch movies, read, get on internet, post your story


7/21
I am in for physical therapy, the best day so far.
The physical therapist, Jennifer, set the goals explains the process and generally instills hope. Finally I see a light at the end of the tunnel.
First day is all about pain. I am told to take a painkiller before coming to PT next time.
It is hard to see what is left of my foot out of the cast.
The exercises are about regaining flexibility in my toes and ankle, a lot of cricking and popping noises coming from the foot, scary.
I am to continue with PT twice a week until the surgery to remove the screws in November.

Lessons learned:
PT makes a world of difference, you will have someone who has seen this injury before and knows what you can and cannot do. Someone to guide you through every movement and someone you can ask a lot of questions that doctors appointment just is not long enough for.
You will get a do-at-home exercises, attend to them religiously.
Your therapist is your partner in the healing, if you do not feel comfortable with the one you have, look around.

<<<< UPDATE>>>>
Since I left of the log in July, I continued going to PT 3 times a week, eventually supplementing the PT exercises with time in the pool. I bought xerosock, a rubber sock you can put over your cast that is completely air tight and does not let water in. I was not permitted to swim and kick with my legs in the pool, but it helped a lot getting out of the house and bed and into the water.
By beginning of September I was able to keep my foot down for about an hour and used that time to go to the gym and work on machines, granted I was VERY weak and could only do about 10 minutes of a work out at first. But I persevered and that 10 minutes slowly grew into an hour of exercise a day.
By the time October 23rd (screw removal) rolled around, I was in a lot better physical and mental shape. The right leg remained a noodle and was shaking with any sort of load, but my left side started to firm up. But the greatest benefit of regular exercise came from a better mental state. I was no longer getting depressed, I could see the progress I was making, although very insignificant but it was positive progress. After spending months upon months watching my body painfully deteriorate, I was finally able to slow that process down (and the reversal was at hand).


October 23rd 2008

Let's get the hardware out.
The idea of hardware removal, as it was explained to me, was to get me back into sports, leaving screws in exposed me to screw breakage (I am a snowboard instructor, besides windsurfing and would like to go back to doing jumps one day).
So the screws had to come out.
Going into the surgery, I had no pain at rest, no pain standing or waling in the CAM boot. Through PT I regained full range of motion and was basically pain free. :)
Remembering quite well the horrors of post op, I lined up family and friends, got an ice machine, stock up on movies and pain killers.
The hardware removal is a MUCH easier surgery to live through, but taken on its own it is still pretty bad.
I was given sedative and was out for the duration of the procedure, I came out ok and immediately started on the full does of oral painkillers (no half doses like the last time), I remained in semi-conscious state for next 2 days. While my family administered the ice and I elevated my foot.
After 2 days I went off the pain killers and felt pretty good about it, considering there was nothing standing between me and my foot, no cast this time, I was able to observe the results of the surgery. Stitches in the same place like after the first surgery, foot swollen, no discoloration.

Oct 27 2008
PT resumes
With my stitches still in I was ordered to show up for PT, that is 4 days post surgery. Needless to say I could not keep my foot down for a reasonable amount of time, but I got check over by PT and started on exercise.

My PT regiment consisted of 3 PT sessions a week augmented with 2 accupancture sessions, I wanted to control the pain without medication.

I continued this rigorous approach to recovery until December 3rd, when I saw my surgeon post op. I was told that I have developed pretty severe case of osteopenia, my bone density was very low. This was caused by me being NWB for such a long time and partial weight exercises in PT just were not enough to stop bone depletion.
My doctor sent me to the pool PT, when you get into a shallow pool and perform walking and other motions, thus getting closer to 100% WB.
From my second pool appointment I developed pretty severe pain in the joins and eventually in the mid foot.
The pain became so severe that I would collapse into the pool not able to step on my right foot. I was advised by the doctors office to keep putting the weight on the foot or I will suffer bone fractures that will jeopardize the recovery, so with the help of accupancture I ventured on.
I was able to increase my WB time to about 3-4 hours a day in tremendous pain, but I knew I had to do it.

The foot showed some continuous bruising that would turn brighter after each PT session and then turn yellowish at the edges next day.

Finally I went to see my doctor for a follow up, February 4 2009.
The good news was that osteopenia has slowed and I was out of the danger zone (woo-hoo). The not-so-good news was that the pain I feel is from arthritis in my mid foot, I also have edema in most of my joints due to load during PT.
I was ordered to take it easy and control the arthritis with pain medication.

This is where I find myself today (2/11/09):
I cannot make a single pain-free step, because of arthritis and edema, I cannot even simply stand without pain.
There is a good chance edema will dissipate with time, but a very painful arthritis is here to say. I am at the loss on what to do from this point on. I am still moving around with crutches or a cane, putting full weight on the foot is just too much pain, I can stumble around by using my heel, but this is no way to live. :(

Feel free to post questions I will try to answer as much as I can.

I also would like to thank every one who has replied to my messages on this board, supported me and helped me along.
[QUOTE=dawindsurfer;3762405]Hello,
I wanted to put together my story of lisfranc joint injury in one post and keep it updated as I go along.
The lisfranc injury requires a very long recovery period, through out this time I had learned a lot, through the internet, this web site, books, doctors and friends. I wanted to share my story and what I have learned.
If you search for my handle you will find a number of posts, but most of them only show a part of the story.


Each lisfranc's injury is different, the treatment plan can vary widely based on each individual doctors take on, what is still a controversial, procedure for a rare injury.

Things to consider when looking at my treatment plan, I was active in sports, I have injured my foot windsurfing, during winter months I used to teach snowboarding. I was looking for a doctor with experience in treating athletes with a similar injury. I needed my foot back in working order to get back to teaching sports. I was told that screws have to come out or there is a good chance I am going to break them during one of the snowboarding jumps. I was also given an option to get a mini tightrope. This is a new device on the lisfranc's market, available since last year (2007) that supposed to prevent re-injury, there is not enough data on the effectiveness of the device as of yet.
If you have a ligamentis lisfrancs (your ligaments are torn) they will not grow back, the way your body fixes itself is with scar tissue. I used BioSil to speed up scar tissue generation, do not know how effective it has been, but my nails grow 3 times as fast :)

Here is my story:

5/31/2008
I was windsurfing on a small lake in Wisconsin, with my feet in straps. I have been windsurfing for 15 years and the day was pretty relaxing with flat water and light gusts. I was racing with my friend and when another gust rolled through I felt very sharp pain in my ankle. It was almost like I had a nail driven through my foot, considering there were nail in the water I figured I might have pinched a nerve and kept on going for another 10 feet. The pain was not going away, it was getting more intense if anything. I let the rig go and fell into the water, the pain was getting to unbearable levels, I suspended my injured foot into the water and waved for help. I felt my foot swelling up and decided to remove the windsurfing booty before the foot is too large and while it is numb from the cold water. That was a good decision. With the foot out and me eventually out of the water I was picked up by my wife. She also had a large beg of ice ready for me, I was able to freeze my foot to a completely numb state and with the help of some alive the pain was subdued to a manageable level.
I waited a day before showing up at the doctors office.
The pain was no longer intense, yet the foot was very swollen, the ankle was looking ok, but the foot - was twice the size and blue was showing on top and bottom of my foot, I have not seen an injury like that before. At this point I had a slight inkling that I might need to see a doctor, this one did not look like something I can just walk off.

Lessons learned:
lisfranc joint damage is a suspect when your foot swells up and blue shows up on the bottom of the foot.
Jumping on one foot to get around is dangerous, get crutches asap


6/2
I went to see a doctor (OS) at Bannokburn office, he took a number of x-rays, a couple of them were load bearing (painful), the diagnosis was that I had a lisfranc sprain with no dislocation and a couple of bone chips. Conservative treatment plan was recommended, meaning - I stay in a hard cast for 8 weeks. At this appointment a fracture I had sustained in my ankle was missed. I was put in a dark blue cast and sent home with a pair of crutches. I was told to show up in 2 weeks for a check up.

Lessons learned:
with foot injuries get a second opinion, always
although it is tempting to think that surgery can be avoided for lisfranc injuries, it is better to face the reality as soon as possible. There are countries in the world that do not do open reductions for lisfranc dislocations, but use different fixation techniques, like setting the bones manually under x-ray and securing them in place with external application of a cast, that gets re-applied when swelling gets down (every 2-3 days). Unfortunately this approach as a low success ratio.
If you are going with a surgery, know that your future walking ability depends on how soon you get the surgery done, post-traumatic arthritis sets in quicker if you wait longer.


6/16
I am back from a follow up, the cast is taken off. By then the swelling is way down and foot is only about 1.5 times the size of the other, blue spots are around toes, but it looks like I am on my way to a speedy recovery. Minimal pain, mostly located around my ankle (remember that missed fracture?), the foot hurts little under pressure exerted during examination. More x-rays are taken, weight bearing x-ray shows separation of 2mm.
I am being asked if I stepped on my foot at all since the cast was put on, I say of course not, as a matter of fact I kept it up all the time to help with the swelling. I was told to wiggle my toes to speed up healing and that was the only thing I did.
I asked about the pain in the ankle, another set of x-rays later I was told I have fractured a bone in my ankle as well.
I am being told that I will need a surgery to fix the lisfranc, my dreams of speedy recovery are crushed, I call on my friends and relatives to find a doctor who would have a different take on the injury, I hope to avoid the surgical intervention at any cost.
I solicit second opinions from as many doctors I can, but getting appointments on such a short notice is almost impossible and the doctors I do get to talk to all tell me that this is very tricky procedure and they do not have enough experience with it to do it well.
In mean while I learn that the sooner I get the surgery the better my chances are going to be. The doctors offering non-surgical treatment give me no guarantees about the results of the treatment, that is not encouraging.
By the time the end of the week rolls around I am totally exhausted, my pregnant wife and my parents are falling of their feet after running from one doc's office to another. My hands are shaky my sides are bruised from crutches. Finally we talk to a doctor who tells us that he has done plenty of the lisfranc surgeries and can do mine as well. But his schedule is booked for next 3 month.
We get on a waiting list.
The x-rays at this appointment showed separation of more than 7mm, looking at my bones floating around my foot cleared any doubts I had about fixing this surgically.

Lessons learned:
If you are diagnosed or suspect lisfranc injury, seek second opinion and just in case get on the surgery list, if you decide not to pursue surgery, you can always cancel the appointment.
If the foot does not hurt much, it does not mean you will be able to walk on it.


6/20
I am called in for a surgery, they had an opening, the only minus the hospital is out-of-network for my insurance. I went for it any way.
I was exhausted, hurting and tired, stressed out of my mind coming in to the hospital. The first IV I got was to calm me down, from there on I just did not care, the drug induced Haze surrounded the procedure. I was given a block followed by general anesthesia.
The last thing I remember was inhaling the gas and when I exhaled I was back in the waiting area. Given 2 vicaden and told to start taking painkillers regularly. And so I did, double dose of Norco 2 hours later, the pain hit about 3 hours post surgery, it was brutal, with anything to take my mind off the pain and counting minutes to the next does of norco, it was hell. The minutes crawled the pain was unbearable, at some point I started talking about going to hospital to get pain control going. But I managed to live through it. More Norco and more. It is hard to remember everything that happened, I had my parents keep watch over me changing ice every half hour on my foot to keep swelling down day and night. Everyone was beat down in three days following the surgery. Even when the pain is under control getting a normal sleep is hard, keeping the foot elevated 24 hours a day is tough on your back and uncomfortable to sleep. But keeping foot up, higher then you heart level, will reduce swelling and assists healing.

Lessons learned:
start Painkillers asap
getting off the painkillers will be an adventure, arrange a weaker prescription ahead of time to get you off the strong stuff
have your relatives and friends lined up, you will need a lot of help
think ahead about getting to the bathroom, it will not be simple, you might want to get a porta-poty and pee-cup ahead of time.
pain eventually goes away, although it does feel like you just pass out from it. Be tough, it will be over.
Have food prepared and stored ahead of time, recover after the surgery can take a long time.


7/18
I am back at the doc's office, the hard cast is taken off and replaced with a walking boot, but no walking is allowed.
In the month preceding this welcomed change, I was in bed, with my foot up. Pain was managed with norco and later with darvocet, pretty successfully over all. I could only get 2 hour long periods of sleep through out this time, turning was a wake up and do it process. My physical condition has deteriorated, the affected leg became a match stick, my overall muscle tone was very low, I lost a lot of strength a lot more the I thought is possible.
I had hard time rolling out of the bed and making it to the bathroom. Each step was a full blown adventure. I could not keep my foot down for more then 5 seconds! make it 2 seconds, I was training it to stay down every day, so the 5 second down was an achievement. I also tried to move my injured foot to keep the muscles alive, but just did not have the strength to do enough of the exercises to make a visible difference.
Please keep in mind that I planned on exercising my upper body and even wrote out the exercises for my abs and legs to do post-op, I developed a list based on the movement restriction (having one leg raised at all times and no sharp movements), but very little reps could be done.
Instead of the exercise I used a device called air-o-sage, a as seen on TV product, that is past its fame, it is composed of inflatable cuffs that you can put on your legs, cuffs inflate to apply gentle pressure and help with circulation.
Using this device made a considerable difference in my healthy leg.

Here is the exercises I planed to do:
(while on my back)
abs crunches (keep my legs up and lift upper body)
with my back on the bed, straight leg lifts
followed by bicycle with my legs while on my back
then
flip slowly on to my stomach and do the leg lifts one at a time to work the hamstrings and butt.
finish the routine off with push ups (keep your legs bent at the knees with feet up).

Lessons learned:
air-massage works
get of the painkillers asap, addiction sets in fast
you will get weak, very weak, be ready.
eat well, eat fiber
exercise as much as you can
if it is painful to keep your foot down for more then a couple of seconds, you can train the foot by lowering it for short period of a time.
keep the foot up ALL of the time (unless you are training)
watch movies, read, get on internet, post your story


7/21
I am in for physical therapy, the best day so far.
The physical therapist, Jennifer, set the goals explains the process and generally instills hope. Finally I see a light at the end of the tunnel.
First day is all about pain. I am told to take a painkiller before coming to PT next time.
It is hard to see what is left of my foot out of the cast.
The exercises are about regaining flexibility in my toes and ankle, a lot of cricking and popping noises coming from the foot, scary.
I am to continue with PT twice a week until the surgery to remove the screws in November.

Lessons learned:
PT makes a world of difference, you will have someone who has seen this injury before and knows what you can and cannot do. Someone to guide you through every movement and someone you can ask a lot of questions that doctors appointment just is not long enough for.
You will get a do-at-home exercises, attend to them religiously.
Your therapist is your partner in the healing, if you do not feel comfortable with the one you have, look around.

<<<< UPDATE>>>>
Since I left of the log in July, I continued going to PT 3 times a week, eventually supplementing the PT exercises with time in the pool. I bought xerosock, a rubber sock you can put over your cast that is completely air tight and does not let water in. I was not permitted to swim and kick with my legs in the pool, but it helped a lot getting out of the house and bed and into the water.
By beginning of September I was able to keep my foot down for about an hour and used that time to go to the gym and work on machines, granted I was VERY weak and could only do about 10 minutes of a work out at first. But I persevered and that 10 minutes slowly grew into an hour of exercise a day.
By the time October 23rd (screw removal) rolled around, I was in a lot better physical and mental shape. The right leg remained a noodle and was shaking with any sort of load, but my left side started to firm up. But the greatest benefit of regular exercise came from a better mental state. I was no longer getting depressed, I could see the progress I was making, although very insignificant but it was positive progress. After spending months upon months watching my body painfully deteriorate, I was finally able to slow that process down (and the reversal was at hand).


October 23rd 2008

Let's get the hardware out.
The idea of hardware removal, as it was explained to me, was to get me back into sports, leaving screws in exposed me to screw breakage (I am a snowboard instructor, besides windsurfing and would like to go back to doing jumps one day).
So the screws had to come out.
Going into the surgery, I had no pain at rest, no pain standing or waling in the CAM boot. Through PT I regained full range of motion and was basically pain free. :)
Remembering quite well the horrors of post op, I lined up family and friends, got an ice machine, stock up on movies and pain killers.
The hardware removal is a MUCH easier surgery to live through, but taken on its own it is still pretty bad.
I was given sedative and was out for the duration of the procedure, I came out ok and immediately started on the full does of oral painkillers (no half doses like the last time), I remained in semi-conscious state for next 2 days. While my family administered the ice and I elevated my foot.
After 2 days I went off the pain killers and felt pretty good about it, considering there was nothing standing between me and my foot, no cast this time, I was able to observe the results of the surgery. Stitches in the same place like after the first surgery, foot swollen, no discoloration.

Oct 27 2008
PT resumes
With my stitches still in I was ordered to show up for PT, that is 4 days post surgery. Needless to say I could not keep my foot down for a reasonable amount of time, but I got check over by PT and started on exercise.

My PT regiment consisted of 3 PT sessions a week augmented with 2 accupancture sessions, I wanted to control the pain without medication.

I continued this rigorous approach to recovery until December 3rd, when I saw my surgeon post op. I was told that I have developed pretty severe case of osteopenia, my bone density was very low. This was caused by me being NWB for such a long time and partial weight exercises in PT just were not enough to stop bone depletion.
My doctor sent me to the pool PT, when you get into a shallow pool and perform walking and other motions, thus getting closer to 100% WB.
From my second pool appointment I developed pretty severe pain in the joins and eventually in the mid foot.
The pain became so severe that I would collapse into the pool not able to step on my right foot. I was advised by the doctors office to keep putting the weight on the foot or I will suffer bone fractures that will jeopardize the recovery, so with the help of accupancture I ventured on.
I was able to increase my WB time to about 3-4 hours a day in tremendous pain, but I knew I had to do it.

The foot showed some continuous bruising that would turn brighter after each PT session and then turn yellowish at the edges next day.

Finally I went to see my doctor for a follow up, February 4 2009.
The good news was that osteopenia has slowed and I was out of the danger zone (woo-hoo). The not-so-good news was that the pain I feel is from arthritis in my mid foot, I also have edema in most of my joints due to load during PT.
I was ordered to take it easy and control the arthritis with pain medication.

This is where I find myself today (2/11/09):
I cannot make a single pain-free step, because of arthritis and edema, I cannot even simply stand without pain.
There is a good chance edema will dissipate with time, but a very painful arthritis is here to say. I am at the loss on what to do from this point on. I am still moving around with crutches or a cane, putting full weight on the foot is just too much pain, I can stumble around by using my heel, but this is no way to live. :(

Feel free to post questions I will try to answer as much as I can.

I also would like to thank every one who has replied to my messages on this board, supported me and helped me along.[/QUOTE]
ok - I guess it's a come to reality day. After finally looking up what lisfranc breaks are ... it's doesnt look great. I know it's only been 6 wks but I am going nuts. I go back in 3 wks to remove screws/pins, and put some weight down. I guess I just thought I would start walking...but from what I have read all day that's not going to be the case. I just finished my first triathlon a month prior to my accidnet. My goal was to do a half ironman later this year and a full next year. Should I hang up my dreams or just post pone for a few years? :(( HOW are you today?
Hello fellow windsurfer,

i had a similar accident while windsurfing. Fractures on 2,3 and 4 with dislocation on 1. I am now 5weeks post op with hard cast feeling better. I am looking for info on long term effect experinces and recovery times. You have not posted after feb 09 and I'm just curious on how are you doing now and if you are back in the water or snowboarding.

Regards,




[QUOTE=dawindsurfer;3762405]Hello,
I wanted to put together my story of lisfranc joint injury in one post and keep it updated as I go along.
The lisfranc injury requires a very long recovery period, through out this time I had learned a lot, through the internet, this web site, books, doctors and friends. I wanted to share my story and what I have learned.
If you search for my handle you will find a number of posts, but most of them only show a part of the story.


Each lisfranc's injury is different, the treatment plan can vary widely based on each individual doctors take on, what is still a controversial, procedure for a rare injury.

Things to consider when looking at my treatment plan, I was active in sports, I have injured my foot windsurfing, during winter months I used to teach snowboarding. I was looking for a doctor with experience in treating athletes with a similar injury. I needed my foot back in working order to get back to teaching sports. I was told that screws have to come out or there is a good chance I am going to break them during one of the snowboarding jumps. I was also given an option to get a mini tightrope. This is a new device on the lisfranc's market, available since last year (2007) that supposed to prevent re-injury, there is not enough data on the effectiveness of the device as of yet.
If you have a ligamentis lisfrancs (your ligaments are torn) they will not grow back, the way your body fixes itself is with scar tissue. I used BioSil to speed up scar tissue generation, do not know how effective it has been, but my nails grow 3 times as fast :)

Here is my story:

5/31/2008
I was windsurfing on a small lake in Wisconsin, with my feet in straps. I have been windsurfing for 15 years and the day was pretty relaxing with flat water and light gusts. I was racing with my friend and when another gust rolled through I felt very sharp pain in my ankle. It was almost like I had a nail driven through my foot, considering there were nail in the water I figured I might have pinched a nerve and kept on going for another 10 feet. The pain was not going away, it was getting more intense if anything. I let the rig go and fell into the water, the pain was getting to unbearable levels, I suspended my injured foot into the water and waved for help. I felt my foot swelling up and decided to remove the windsurfing booty before the foot is too large and while it is numb from the cold water. That was a good decision. With the foot out and me eventually out of the water I was picked up by my wife. She also had a large beg of ice ready for me, I was able to freeze my foot to a completely numb state and with the help of some alive the pain was subdued to a manageable level.
I waited a day before showing up at the doctors office.
The pain was no longer intense, yet the foot was very swollen, the ankle was looking ok, but the foot - was twice the size and blue was showing on top and bottom of my foot, I have not seen an injury like that before. At this point I had a slight inkling that I might need to see a doctor, this one did not look like something I can just walk off.

Lessons learned:
lisfranc joint damage is a suspect when your foot swells up and blue shows up on the bottom of the foot.
Jumping on one foot to get around is dangerous, get crutches asap


6/2
I went to see a doctor (OS) at Bannokburn office, he took a number of x-rays, a couple of them were load bearing (painful), the diagnosis was that I had a lisfranc sprain with no dislocation and a couple of bone chips. Conservative treatment plan was recommended, meaning - I stay in a hard cast for 8 weeks. At this appointment a fracture I had sustained in my ankle was missed. I was put in a dark blue cast and sent home with a pair of crutches. I was told to show up in 2 weeks for a check up.

Lessons learned:
with foot injuries get a second opinion, always
although it is tempting to think that surgery can be avoided for lisfranc injuries, it is better to face the reality as soon as possible. There are countries in the world that do not do open reductions for lisfranc dislocations, but use different fixation techniques, like setting the bones manually under x-ray and securing them in place with external application of a cast, that gets re-applied when swelling gets down (every 2-3 days). Unfortunately this approach as a low success ratio.
If you are going with a surgery, know that your future walking ability depends on how soon you get the surgery done, post-traumatic arthritis sets in quicker if you wait longer.


6/16
I am back from a follow up, the cast is taken off. By then the swelling is way down and foot is only about 1.5 times the size of the other, blue spots are around toes, but it looks like I am on my way to a speedy recovery. Minimal pain, mostly located around my ankle (remember that missed fracture?), the foot hurts little under pressure exerted during examination. More x-rays are taken, weight bearing x-ray shows separation of 2mm.
I am being asked if I stepped on my foot at all since the cast was put on, I say of course not, as a matter of fact I kept it up all the time to help with the swelling. I was told to wiggle my toes to speed up healing and that was the only thing I did.
I asked about the pain in the ankle, another set of x-rays later I was told I have fractured a bone in my ankle as well.
I am being told that I will need a surgery to fix the lisfranc, my dreams of speedy recovery are crushed, I call on my friends and relatives to find a doctor who would have a different take on the injury, I hope to avoid the surgical intervention at any cost.
I solicit second opinions from as many doctors I can, but getting appointments on such a short notice is almost impossible and the doctors I do get to talk to all tell me that this is very tricky procedure and they do not have enough experience with it to do it well.
In mean while I learn that the sooner I get the surgery the better my chances are going to be. The doctors offering non-surgical treatment give me no guarantees about the results of the treatment, that is not encouraging.
By the time the end of the week rolls around I am totally exhausted, my pregnant wife and my parents are falling of their feet after running from one doc's office to another. My hands are shaky my sides are bruised from crutches. Finally we talk to a doctor who tells us that he has done plenty of the lisfranc surgeries and can do mine as well. But his schedule is booked for next 3 month.
We get on a waiting list.
The x-rays at this appointment showed separation of more than 7mm, looking at my bones floating around my foot cleared any doubts I had about fixing this surgically.

Lessons learned:
If you are diagnosed or suspect lisfranc injury, seek second opinion and just in case get on the surgery list, if you decide not to pursue surgery, you can always cancel the appointment.
If the foot does not hurt much, it does not mean you will be able to walk on it.


6/20
I am called in for a surgery, they had an opening, the only minus the hospital is out-of-network for my insurance. I went for it any way.
I was exhausted, hurting and tired, stressed out of my mind coming in to the hospital. The first IV I got was to calm me down, from there on I just did not care, the drug induced Haze surrounded the procedure. I was given a block followed by general anesthesia.
The last thing I remember was inhaling the gas and when I exhaled I was back in the waiting area. Given 2 vicaden and told to start taking painkillers regularly. And so I did, double dose of Norco 2 hours later, the pain hit about 3 hours post surgery, it was brutal, with anything to take my mind off the pain and counting minutes to the next does of norco, it was hell. The minutes crawled the pain was unbearable, at some point I started talking about going to hospital to get pain control going. But I managed to live through it. More Norco and more. It is hard to remember everything that happened, I had my parents keep watch over me changing ice every half hour on my foot to keep swelling down day and night. Everyone was beat down in three days following the surgery. Even when the pain is under control getting a normal sleep is hard, keeping the foot elevated 24 hours a day is tough on your back and uncomfortable to sleep. But keeping foot up, higher then you heart level, will reduce swelling and assists healing.

Lessons learned:
start Painkillers asap
getting off the painkillers will be an adventure, arrange a weaker prescription ahead of time to get you off the strong stuff
have your relatives and friends lined up, you will need a lot of help
think ahead about getting to the bathroom, it will not be simple, you might want to get a porta-poty and pee-cup ahead of time.
pain eventually goes away, although it does feel like you just pass out from it. Be tough, it will be over.
Have food prepared and stored ahead of time, recover after the surgery can take a long time.


7/18
I am back at the doc's office, the hard cast is taken off and replaced with a walking boot, but no walking is allowed.
In the month preceding this welcomed change, I was in bed, with my foot up. Pain was managed with norco and later with darvocet, pretty successfully over all. I could only get 2 hour long periods of sleep through out this time, turning was a wake up and do it process. My physical condition has deteriorated, the affected leg became a match stick, my overall muscle tone was very low, I lost a lot of strength a lot more the I thought is possible.
I had hard time rolling out of the bed and making it to the bathroom. Each step was a full blown adventure. I could not keep my foot down for more then 5 seconds! make it 2 seconds, I was training it to stay down every day, so the 5 second down was an achievement. I also tried to move my injured foot to keep the muscles alive, but just did not have the strength to do enough of the exercises to make a visible difference.
Please keep in mind that I planned on exercising my upper body and even wrote out the exercises for my abs and legs to do post-op, I developed a list based on the movement restriction (having one leg raised at all times and no sharp movements), but very little reps could be done.
Instead of the exercise I used a device called air-o-sage, a as seen on TV product, that is past its fame, it is composed of inflatable cuffs that you can put on your legs, cuffs inflate to apply gentle pressure and help with circulation.
Using this device made a considerable difference in my healthy leg.

Here is the exercises I planed to do:
(while on my back)
abs crunches (keep my legs up and lift upper body)
with my back on the bed, straight leg lifts
followed by bicycle with my legs while on my back
then
flip slowly on to my stomach and do the leg lifts one at a time to work the hamstrings and butt.
finish the routine off with push ups (keep your legs bent at the knees with feet up).

Lessons learned:
air-massage works
get of the painkillers asap, addiction sets in fast
you will get weak, very weak, be ready.
eat well, eat fiber
exercise as much as you can
if it is painful to keep your foot down for more then a couple of seconds, you can train the foot by lowering it for short period of a time.
keep the foot up ALL of the time (unless you are training)
watch movies, read, get on internet, post your story


7/21
I am in for physical therapy, the best day so far.
The physical therapist, Jennifer, set the goals explains the process and generally instills hope. Finally I see a light at the end of the tunnel.
First day is all about pain. I am told to take a painkiller before coming to PT next time.
It is hard to see what is left of my foot out of the cast.
The exercises are about regaining flexibility in my toes and ankle, a lot of cricking and popping noises coming from the foot, scary.
I am to continue with PT twice a week until the surgery to remove the screws in November.

Lessons learned:
PT makes a world of difference, you will have someone who has seen this injury before and knows what you can and cannot do. Someone to guide you through every movement and someone you can ask a lot of questions that doctors appointment just is not long enough for.
You will get a do-at-home exercises, attend to them religiously.
Your therapist is your partner in the healing, if you do not feel comfortable with the one you have, look around.

<<<< UPDATE>>>>
Since I left of the log in July, I continued going to PT 3 times a week, eventually supplementing the PT exercises with time in the pool. I bought xerosock, a rubber sock you can put over your cast that is completely air tight and does not let water in. I was not permitted to swim and kick with my legs in the pool, but it helped a lot getting out of the house and bed and into the water.
By beginning of September I was able to keep my foot down for about an hour and used that time to go to the gym and work on machines, granted I was VERY weak and could only do about 10 minutes of a work out at first. But I persevered and that 10 minutes slowly grew into an hour of exercise a day.
By the time October 23rd (screw removal) rolled around, I was in a lot better physical and mental shape. The right leg remained a noodle and was shaking with any sort of load, but my left side started to firm up. But the greatest benefit of regular exercise came from a better mental state. I was no longer getting depressed, I could see the progress I was making, although very insignificant but it was positive progress. After spending months upon months watching my body painfully deteriorate, I was finally able to slow that process down (and the reversal was at hand).


October 23rd 2008

Let's get the hardware out.
The idea of hardware removal, as it was explained to me, was to get me back into sports, leaving screws in exposed me to screw breakage (I am a snowboard instructor, besides windsurfing and would like to go back to doing jumps one day).
So the screws had to come out.
Going into the surgery, I had no pain at rest, no pain standing or waling in the CAM boot. Through PT I regained full range of motion and was basically pain free. :)
Remembering quite well the horrors of post op, I lined up family and friends, got an ice machine, stock up on movies and pain killers.
The hardware removal is a MUCH easier surgery to live through, but taken on its own it is still pretty bad.
I was given sedative and was out for the duration of the procedure, I came out ok and immediately started on the full does of oral painkillers (no half doses like the last time), I remained in semi-conscious state for next 2 days. While my family administered the ice and I elevated my foot.
After 2 days I went off the pain killers and felt pretty good about it, considering there was nothing standing between me and my foot, no cast this time, I was able to observe the results of the surgery. Stitches in the same place like after the first surgery, foot swollen, no discoloration.

Oct 27 2008
PT resumes
With my stitches still in I was ordered to show up for PT, that is 4 days post surgery. Needless to say I could not keep my foot down for a reasonable amount of time, but I got check over by PT and started on exercise.

My PT regiment consisted of 3 PT sessions a week augmented with 2 accupancture sessions, I wanted to control the pain without medication.

I continued this rigorous approach to recovery until December 3rd, when I saw my surgeon post op. I was told that I have developed pretty severe case of osteopenia, my bone density was very low. This was caused by me being NWB for such a long time and partial weight exercises in PT just were not enough to stop bone depletion.
My doctor sent me to the pool PT, when you get into a shallow pool and perform walking and other motions, thus getting closer to 100% WB.
From my second pool appointment I developed pretty severe pain in the joins and eventually in the mid foot.
The pain became so severe that I would collapse into the pool not able to step on my right foot. I was advised by the doctors office to keep putting the weight on the foot or I will suffer bone fractures that will jeopardize the recovery, so with the help of accupancture I ventured on.
I was able to increase my WB time to about 3-4 hours a day in tremendous pain, but I knew I had to do it.

The foot showed some continuous bruising that would turn brighter after each PT session and then turn yellowish at the edges next day.

Finally I went to see my doctor for a follow up, February 4 2009.
The good news was that osteopenia has slowed and I was out of the danger zone (woo-hoo). The not-so-good news was that the pain I feel is from arthritis in my mid foot, I also have edema in most of my joints due to load during PT.
I was ordered to take it easy and control the arthritis with pain medication.

This is where I find myself today (2/11/09):
I cannot make a single pain-free step, because of arthritis and edema, I cannot even simply stand without pain.
There is a good chance edema will dissipate with time, but a very painful arthritis is here to say. I am at the loss on what to do from this point on. I am still moving around with crutches or a cane, putting full weight on the foot is just too much pain, I can stumble around by using my heel, but this is no way to live. :(

Feel free to post questions I will try to answer as much as I can.

I also would like to thank every one who has replied to my messages on this board, supported me and helped me along.[/QUOTE]





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