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I suffered a lisfranc injury after having a 300 pound piece of lumber dropped on my left foot. Although I was suffering bad pain, I walked on it for the next 4 hours and opted to go to the doctor's the next morning after waking up and finding out it was impossible to put any weight on it whatsoever. Some x-rays were taken and no break was found, and I was scheduled an appointment with a foot specialist the next day. After an MRI, they found out I had a lisfranc injury, but apparently not one severe enough for surgery. They placed me in a boot and told me I couldn't walk for 6 weeks.

Pain is minor. In fact, most of the time there isn't any at all. Some dull pain comes up every once and awhile, but the swelling is what's worst. It's still pretty big, and my foot is purple and black, with blotchy purple bruising around the toes. There have been a few times while wearing the boot that I've accidentally slipped off my crutches and put weight on my foot.

I have a couple of questions:

1) What are problems I'm likely to have down the road? What are the odds of a complete recovery?

2) Should I be wearing by boot even when I'm at home lying on the couch or sleeping?

3) Is it still necessary to elevate and ice my foot?

This injury is really annoying. It's made it hard to work or do anything with my friends. I keep seeing stories about how people are limping for the rest of their lives or their foot is deformed/permanently swollen. Any words of advice would really help.

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Don't know that I can really answer your question--I went ahead and had the surgery after 6 weeks of recovery--but I can give you some idea of what my experience has been like.

Back in March 2012, I missed the last of three steps and heard a horrible popping noise as my foot twisted and my weight came down on it.  My primary care physician correctly guessed the I had either a lisfranc or navicular fracture based on the swelling and bruising, which was pretty dramatic. She did a weight-bearing X-Ray that didn't reveal any fractures but, suspecting a more severe injury, she  ordered a CAT scan.  When the insurance company denied her request, she referred me to an orthopedist.

Based on a second round of weight-bearing Xrays, the physician's assistant at the orthopedist decided I probably only had a sprain and didn't need a CAT scan.  He put me in an orthopedic shoe, and I hobbled along for about 6 weeks and was actually doing pretty well.  The bruising and much of the swelling improved, but I still limped and had pain in my arch/midfoot.  I could get around but it still seemed (to me) that something wasn't right, so I requested another appointment and insisted on seeing the orthopedist.  When I described the pain, he ordered an MRI which revealed two hairline fractures in my toes and a complete break of my lisfranc ligament.  The second metatarsal was dislocated about 2mm, which is--I'm told-- a fairly minor dislocation in the world of lisfranc injuries but still enough to cause big problems. 

At that point, the orthopedist said he'd let me make the decision about having surgery.  I could go along as I was or opt to have a single screw put in to stabilize the joint.  He [the orthopedist] indicated that while I'll probably have arthritus in my foot either way,  it'd be worse if I didn't have the surgery.  The pain just bad enough, and the joint unstable enough, that I opted for the surgery even though I was almost two months past the original injury and relatively mobile.

The surgery itself wasn't THAT bad, but I spent two weeks in a splint and four weeks in a "moonboot."  I wasn't allowed to put any weight on my foot so that pretty much meant lying on the couch, hobbling around on crutches, or using a knee cart that I rented (and highly recommend).  The surgery was June 19.  On July 30th, the orthopedist gave me the OK to put weight on my foot (in the boot) and begin physical therapy. 

I'm two weeks into physical therapy now and finding it very helpful.  Even in I hadn't had the surgery , I think the physical therapy would have been useful.  You might ask your doctor if he thinks it would be appropriate in your case.  Truthfully, I still have a limp and a fair amount of pain (especially when I go up and down the stairs), but the surgery did make my foot feel much more stable.  Eventually, I think I'll be able to walk without pain or a limp--something I'm not sure I would have ever been able to say that had I not had the surgery.  Of course, that is really just speculation.

I can tell you that when I was non-weight bearing, my doctor said it was OK to take the walking boot off at night and when I was resting/watching TV.  I tried to keep my foot elevated as best I could, whether the boot was on or off, for at least a month.  I got one of those wedge pillows and just plopped my foot down on it whenever I was on the couch or in bed.  I also iced my foot for four days after surgery and then whenever it hurt for another two weeks.  The physical therapist I'm working with ices it after each session and suggests that I do so whenever I use my foot more than normal.  It definitely helps me with any discomfort and--since it doesn't hurt anything--I'd recommend doing it whenever you are in pain.

Hope all this helps.  Best of luck in your recovery.

Joyce
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hi, can you tell me how things turned out for you? our injuries sound similar. i am scheduled for surgery tues but am thinking of cancelling ... i am a borderline case for surgery. trying to decide what to do. thanks ...

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I remember going through many online forums when recovering from my own lisfranc injury and I was often left a bit depressed by the general recovery rate. From what I’ve learnt each case is different so to try to predict how one case will recover from the next is quite difficult but hopefully my own experience can shed some light and give some hope.

Summary of my experience:
- 2-3mm dislocation no break
- 4 month to diagnose
- Was 50/50 in regard to surgery but elected to go the conservative root.
- 1-2 month good but misleading improvement
- 2-8 months very little recovery
- 8-10 month with slow exercise progression on soft surface and right footwear I had amazing recovery
- 20 months down, Slight weakness remains in toes when sprinting but particularly when jumping.

I sustained my injury in May 2011 while playing Australian Rules football. I was tackled while I had my toe pointed to kick the ball along the ground and stepped awkwardly while twisting. At that point I could still bear weight but after icing it was unable to bear any weight for about 3 days. The next day I went to the GP and he indicated that it was very difficult to damage that part of the foot and said I’d be OK to play within a few weeks. A month past and I was still limping and often felt sharper pain maybe 5 times a day when doing irregular movements. I went back to the GP and was sent for X-Rays which were useless and revealed nothing. I was given a referral to see an Orthopaedist who sent me to get an MRI which finally revealed a 2-3 mm displacement between the 1st and 2nd metatarsal. All up it took almost 4 months to be diagnosed.

I was recommended to get custom made orthotics which took a further month to get made up and I didn’t attempt to run/ jog until 5 months post injury. Initially I found the orthotic to sit too far back in the shoe as my foot was being pushed forward by the runner padding around my Achilles and instead of supporting the arch it was doing the opposite. I decided to buy a new pair of runners a size smaller to ensure that my foot would be forced back in the shoe to align with the orthotic and it did the trick. Looking back I think the orthotic and the right runner was crucial.

My initial attempts to run generally started well but after a mile or so a sharp pain would stop me in my tracks and I’d hobble back home. The foot wasn’t getting any better in fact I’d say there was very little improvement from 1 month to around month 8 or 9. By about month 7 I’d given up hope of playing the upcoming season and turned my attention to American style punting to just keep me fit and involved with a physical activity. It was becoming apparent that my athletic days may have passed and I think my lowest point was at around month 8 when punting a ball with friends they looked shocked at my lack of recovery as I was literally hobbling around after the ball.

By month 9 I decided to go down to preseason training out of desperation and started by jogging a lap of the field. The next time I jogged 2 laps and this continued until I was jogging around 8 laps with breaks. By keeping my progressions small I was able to reduce the frequency of the sharp pains. Month 10 was a good month for me I went from still having the occasional sharp pain when walking and jogging to almost overnight having no sharp pain. I went about 3 weeks without any pain and slowly joined in with the group. My goal went from just staying fit and sane to setting a comeback date.

By the 12 month point I played my first game and played a further 12 games for the season without issue. I’ve literally had no pain in my foot since this point but have noticed that I have no explosive power in my toes and cannot jump as high off that foot, however my sprinting speed hasn’t been greatly affected apart from my hip and knee compensating for the lack of power in my toes. I would say that now 20 months down the track I’m at above 95% recovered and unless I was trying to reach fairly elite standards for the average person I’d say 99% recovered.

Looking back I think the key for me was to progress very slowly as every time I pushed it, it failed. If I could run an extra 50m than the day before it was a win and I would stop. For me it was a fine line between regression and progression and it was about getting tiny progressions per day which added up over time. I also think having a custom orthotic, the right shoe and a soft running surface were beneficial. If I was giving one bit of advice it would be; find what you can do without discomfort and aim to do 1% more each day.
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