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After reading many of the posts, it's sad to hear that so many people struggle to recover from their lisfranc injuries. I'm optimistically hoping that most of the folks who have previously posted their stories eventually recover well and just forget to post a follow-up message letting everyone know how great they're doing!

I just posted a message above that briefly describes my injury but wanted to ask if anyone else has had there lisfranc fracture "externally fixated"? I thought i was getting surgery to just put a couple of screws in my 1st and 2nd metatarsals and the doctor ended up also putting 3 rods that stick out of my foot which look like something from my erector set that i had as a little kid. Are these rods the same thing that people are referring to when they say they had "pins" put in? In any event, they are extremely uncomfortable and I can't wait to get them out. Can anyone tell me how painful it is when they are removed? thanks!

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I also had external fixation. The 3 rods were removed 5 weeks post op. The first time I viewed them at my f/u, I nearly lost consciouness. My purple, swollen, sutured, lump of a foot looked like it belonged to a cadaver...very creepy and surreal.
The 1st two pins came out relatively smoothly and with only moderate discomfort. The last pin was bent, they reported, and required 5 full minutes of tugging by increasingly strong healthcare providers and a series of different pliers. I'm not going to lie, this was torturous.
I'm 5 mos post op now, and I have been walking for 2 mos. My recovery has been excellent!! I'm running and hiking again and my sugeon and PT expect I'll continue to do well!!!
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Thanks for your response. I'm 3 months post-op now and started PT 1 week ago. I'm in a boot and still can't fully put my weight on my foot. It's great to hear that your surgery turned out so well. It also gives me a glimmer of hope. Can I ask you a couple of questions: (1) how many screws did you have in your foot, (2) did they take the screws out already and, if not, when do they plan on taking them out if ever, and (3) how long were you non-weightbearing and how long did it take for you to walk once the doctor allowed weight-bearing? Sorry for all the questions but I'm kind of starting to freak out a bit given that I still can't fully bear weight on my foot. This has been a pretty long and arduous process and I can't wait to be able to just walk on my own, moreless surf, play sports and run again.
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Thanks for your response. I'm 3 months post-op now and started PT 1 week ago. I'm in a boot and still can't fully put my weight on my foot. It's great to hear that your surgery turned out so well. It also gives me a glimmer of hope. Can I ask you a couple of questions: (1) how many screws did you have in your foot, (2) did they take the screws out already and, if not, when do they plan on taking them out if ever, and (3) how long were you non-weightbearing and how long did it take for you to walk once the doctor allowed weight-bearing? Sorry for all the questions but I'm kind of starting to freak out a bit given that I still can't fully bear weight on my foot. This has been a pretty long and arduous process and I can't wait to be able to just walk on my own, moreless surf, play sports and run again.
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Your questions are always welcome!

(1) & (2) I went through a series of consultations with orthopods after my diagnosis and the dr. I decided on opted to use an arthrex tight rope instead of screws, since the screws loosen and often have to be removed.

(3) I was non weight bearing for ~2mos and then partial weightbearing for another month in a boot, though it felt too shaky to walk on, so I continued to use my crutches with the boot. I was able to take my 1st clumsy,unaided, bootless steps the day the doctor told me I could bear full weight, 3mos post op.

I understand your frustration. This injury will tax your patience to no end. Waiting and hoping for the best does is not my usual style either.

My only suggestion is to consult with different orthopedic foot/ankle specialists to confirm that your surgeon's treatment is sound. If their opinions are all in alignment, this should provide some comfort and might temper your frustration for now. If not, then you will at least have some different options or solutions to consider. If you are able to, schedule with an orthopod who works with professional athletes, as they tend to be better credentialed and more experienced.
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Ok, thanks for your answers. Ironincally, I went to see my "new" doctor this morning who is the team doctor for an NFL team and he wants to take my screws out in two weeks and put in the tightrope system. He said that it would be minimally invasive and that i would be able to continue physical therapy a few days following the procedure. Seems pretty aggressive but what do i know, right?

I've now spoken to 4 different doctors and, sadly, each one has told me different things regarding screw removal and the amount of time someone with this sort of injury should remain non-weightbearing post op. The doctor who peformed my surgery was a DPM who specializes in foot and ankle surgery. He wanted me non-weightbearing for 3 months post op and never wanted to take my screws out. That seemed to extreme and debillitating to me so I went to go see the sports orthopedic surgeon who I'm seeing now. he's not an "orthopod" though but seemed well versed in the tightrope which seems to be fairly cutting edge. Other doctors that I have talked to have said they would take screws out anywhere from 4-12 months post op but did not mention the tightrope. So at this point, as you can imagine, I'm kind of at a loss for what to do but i'm leaning towards letting the "new" doctor take the scews out and put in the tightrope, which he says stays in my foot permanently.

The "new" doctor knows that i played soccer in college and still play a number of sports so he seems pretty adamant that his method will get me back to the things i enjoy as soon as possible. Any insight you can provide on how the tightrope feels in your foot would be great? can you actually feel it in there? Do you have any pain when you run or hike now? Thanks.
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I do still have pain during most all weightbearing activities. I'm @ ~3/10 walking, ~4/10 hiking and ~5/10 running. This continues to to improve though. Running and hiking cause swelling & stiffness, which are also getting progressively better. I purchased 'super feet' inserts a month ago and they eliminated ~95% of my limp immediately..great product!!

As for the tightrope and how it feels, really I don't feel it. The stiffness, swelling and discomfort in my foot are not localized to the site of the tightrope. Can you feel your screws??

How well were your dislocations reduced? Did the doctor say he could improve the existing reduction with a tightrope? The better the reduction (they are rated poor-excellent), the better the long term outcome. The tight ropes better maintain the reduction, as I understand. Even if your reduction is already excellent, I'd go with the new doc's plan for the maintenance factor.

....Weightbearing & Outcomes......

All of the doctors I spoke with, from the ER to my 4th consult, agreed I'd be off of my foot for ~ 3 months. The rehab protocols I've read have varied a bit, but 2-3 months nonweightbearing seemed to be the average.

Here is a great compilation of information, and the rehab protocol addresses your situation (ORIF with external fixation and screw placement): eorif.com/AnkleFoot/Lisfranc%20tech.html. The site is intended for surgeons and replete with citations. It states @ three mos. post op weaning off the boot should take place. My doctors and PTs encouraged me to lose the cam boot asap, as prolonged use can cause permanent mechanical/arch problems.

This study reports an average of 4.75 months to resume pre injury activities, but the (fracture) sample size is only 4 and they did not have the ORIF procedure:
osteoporoz-osteoartrit.org/aas/1999/pdfs/vol10no2-10.pdf

These studies looked at functional outcome after our injury type:
ejbjs.org/cgi/content/abstract/82/11/1609
osteoporoz-osteoartrit.org/aas/1999/pdfs/vol10no2-10.pdf
(The bum skinny, unfortunately, is that ~25% of us will not fare well: pain, arthritis, major lifestyle changes)
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I have a very serious lisfranc fracture. And an excellent orthpod specialist who soley does ankle/foot repairs. Accident occurred 2/26, specialist out of town, saw him 3/2. First 2 options discussed were 1)plates and pins with a second surgery to remove them, or 2)fusion of the fractured bones using a bone graft. Additional CTs on 3/4 to fully define extent of fracture. First metatarsal dislocated and will be repaired using an incision on inside of foot no matter what option was used. 2nd and 3rd metatarsals fractured at the head and the tarsals (knuckles) above them badly shattered. Dr could try pins and plates but pieces are tiny shards, but very likely joint would develop arthritis,and fusion surgery would be needed to address the arthritis. I decided that fusion would be best under the circumstances but am still worried about overall impact on mobility and flexibilty. I am a 62 yr old female that does alot of long distance biking and hiking and regular strenuous gym workouts.

Today a 3rd option was raised by DR. External fixation drilling into good bone on either side of shattered joints, attaching an erector set like device externally, tightening it to pull the pieces together, and leaving it in until the bones have healed in place. If this did not solve the problem or if arthritis came later, then the fusion could be done.

I am undecided. Any thoughts would be appreciated. I will talk to DR again Monday morning 3/9 and decide then which way to go. What is the tightrope?
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Did you end up going the external fixation route and if so how was the recovery?
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