Lisfranc Did Fusion Help Your Pain

Hi all. I think I can offically say I've read every post about lisfranc injuries on this site. But I though my first post should be on this one as it's most relevant. In Sep 07 I was a passenger in a serious car accident. My left foot was crushed in the foot well of the van which cause serious damage. I have punctures and fractures and totally ruptured ligaments. My foot was crushed in a pointed position. And I was diagnosed a month later with a lisfranc fracture. My midfoot bones were splayed when my foot was crushed. To get this diagnosis I had to go through a crappy hospital who sent me home the next day, 2 useless GP's who just wanted to dress the external wounds, and a crappy specialist. I forced the second GP to refer me to an ortho, and the one I went to was pushing surgery. He would say why or back it up, he just wanted me out of his office and under the knife. So I found another who would talk to me like he should. My whole family are involved in science, so we can understand a more complex explination. This doctor decided it was too late to do micro surgery to fix the ligaments and muscles, and that the fractures would heal themselves. With the lisfranc he decided the gap was boarder line, but after consulting other ortho foot specialists he decided screws were not needed now. So I sat through 3 months of non weight bearing. This was with a simple soft ankle brace. Too much tissue damagr for a cast or boot. My foot was a mess, so I wasn't inclined to go anywhere. After 3 months it took me around a month to get back walking fairly normal. I even started dance again and entered a salsa comp. However 9 months after the crash it started to hurt a lot more again. My ankle always gave me trouble, but it was manageable. But now my midfoot was giving me grief. I tried acupuncture and after a MRI we found arthritis and more odema, ontop of the old injuries. So I had a cortozone injection at the arthritis site. It was magic. Till my doctor said a fusion would fix the problem. He said that I was very young at 21 for the procedure, but he would do it if the benefits would be worth it. He warned that a fusion will put stress on nearby joints, which may result in furture fusions. But I need my life back and if that's the only option so be it. I can't do my profession, or complete Uni or dance which is my passion. And due to my year of sluggish downtime I put on weight. Which I was keen to get rid of. So last Fri I had 3 screws to join my cunieforms, and a bone fusion to join the inner two. (bone from below my knee). I'm in bed currently feeling sorry for myself. From reading these forums I gong like my chances, but I'm trying to think positive. I'm happy to answer any questions, or to recieve info on my road ahead.

Thanks in advance.

It is great to read that your progress so far is going well. In the long run you will be so much happier with that fused foot compared to what you had prior to it. Keep us posted on your progress as I am sure others to will want to hear more about fusion as an option for this terrible injury.

I am wondering if anyone has any info or experience with a fairly new technique called ceramic implant arthroplasty instead of fusion. It is basically an artificial joint. I am a new poster to this forum, but have been reading all your stories for the last 18 months since my lisfranc injury happened. My timeline is: 9/17/07 accident, tripped in kitchen. 9/24/07 had surgery to implant 3 screws and 2 pins. 1/29/08 surgery to remove hardware. 6 months of PT starting in 12/07. Sept. 08 still having lots of pain and back to limping. Decided to seek another opinion in Boston. Told that severe arthritis was in the joint. Gave me a steroid injection which helped immensely and I was 100% back to pre-injury activity. Jan. 09 shot wore off. Back to exteme pain. Doc says I cannot keep getting injections as they will not be effective and can damage bones and ligaments. Suggesting this new ceramic implant technique before opting for fusion which is irreversible. Any info on this or fusion would be appreciated. Thanks!!

Lisfranclady,

I read your post and I also live in Boston. I went to all the prominent foot/ ankle orthos at all the big hospitals in the city before settling with Dr. Micheal Wilson out of Brigham and Womans at Faulkner branch. He was the most experienced and was told he was the best even by his peers.

I had fusion with him on 12/29/08 and am doing well. Walking in a boot now(limited discomfort) and will be in a shoe next week. Arthroplasty has not been proven as a long term success and could wear out with alot of pain. I was told this by several orthos. I could not imagine having to open this foot up again and going thru all the pain on a gamble.

My foot now feels close to the other one, just a bit more stiff. I'll take stiff over pain anyday.

Let me know who your working with and i could prob give you the other big names I saw as oppinions on this subject.

good luck...

Deano73 -- thank you so much for your response and info. I am working with Dr. DeAsla (MGH). I have been trying to get an answer from Dr. Wilson's office for over a week now after inquiring as to whether or not he even performs ceramic implant and whether or not it would be worth my while to seek his opinion. The only other doctor I have spoken to this about is Dr. Robert Anderson (who pioneered it) from Ortho North Carolina.
I am anxious to know who else you sought opinions from and, also, which joint did you have fused? I am told that I need the joint between the fourth and fifth tarsometatarsal fixed and if they were to fuse it my foot would be VERY stiff. I, like you, will take stiff over pain, but I do not want to be limping around because I can't move my foot. Both my original ortho and Dr. DeAsla say that fusion for this particular joint should be the last option. With all that said, I do realize ceramic implant is a huge gamble and am having an extremely hard time with this decision.

Hi Ladylisfranc,

OK i'll give you all the info I have. I saw all these people for oppinions since I was just like you about the whole fusion thing.

Dr. Navin Dugal Beth Isreal Deacons in Downtown BOS
Dr. Slovenki Boston Sports and shoulder - Brookline, MA and NEW ENG. Baptist HOSP.

Dr. Micheal Wilson - Brig and Womens hosp.

Now These are " The big Three" Foot and Ankle Orthos in Boston-- All of New England for that matter. I was told this by countless medical proffesionals and My own personal research. I'm sure there are many other great surgens out there, but these name kept comming up everywhere I went. I would ask alll the Dr.s I saw " who else should I see for there oppinion" and every Dr. said these names.

I also went to Harvard Med. and asked there Dept. Who I should see. They All said Dr. Wilson with no hesitation.

Then I went to Foxboro stadium and asked who the PATs use. They sain Wilson or Slovenki.

Then I saw both Wilson and Slovenki. At the appt. with Slovenki he asked who else I have seen. When I told him I was also working with Dr. M Wilson he said- " well honestly there is no one better. I know feet, but MW really is the best." This confirmed my choice and I have not regretted it at all. He was great and knew exactly where I hurt and was the only one to show and tell me why I was in soooooo much pain.

I am 10 weeks in and am in very little discomfort. I had the first two METs and the first two cuneiforms fused. In all 4 bones and 3 joints fused in what I was told a quite imoble area in the first place. I was called a 4 corner fusion.

The 4th and 5th Mets are an entirely different beast from what I have researched. Your Dr.s will help you understand why. These are very mobile joints because the cuboid is a key bone for foot mechanics. This must be the reason why your surgen is hesitant.

Dr. W is VERY HARD to get an appt. with. People from all over the country fly in to see this man. I actually got my first appt. with a 4 month wait, so I went down to the hospital in person and sat and waited for his personal appt. person to come in. I was able to get in 2 weeks later. I have that # if you want it, but I wont put it out on this board for many reasons.

Let me know how your doing.

Deano73 - Again, thank you for the invaluable information. I think you may be talking about Patrick who, finally, just returned my call. He stated that MW does not perform ceramic implant, but booked me an appt. on 4/3 to see him for another opinion of my circumstance. So, I feel good about being able to get his opinion and information. After hearing exactly what you had fused vs. where they say my problem is, it will be interesting to see if he concurs with the other Drs. that say try ceramic implant first. The reason I'm anxious is because I am of the understanding that ceramic implant is only viable for the 4th & 5th METs which, if true, was not where your problem was and, therefore, would not have been an option for you. Can you tell me anything further regarding your discussion of ceramic implant with either of the Drs. you visited?
Thanks, again, and I am happy to hear that for you it seems as if your perserverance and research has paid off and you are well on your way to getting around pain free! It does make it easier for me to keep looking for the best alternative for me.

hi LadyLisfranc....

sounds like we are in a similar situation as I had a lisfranc injury to all 5 mets, but due to gait problems, etc. am having some breakdown and spurring of the 4th and 5th tarsal-metatarsal joints. These are a bit more than 1-3 as I know have a good orthotic stabilizing the medial lisfranc joint. So I am very curious as to what you find out regarding ceramic inserts as well as if there is any point to having bones spurs removed, etc. I can tell you that prolotherapy has been helpful for me as I acutally had a bit of hypermobility in the area and it helps rejuvenate cartilage. Whatever you can find out would be greatly appreciated.


**edited by moderator**

hundredwaters, I am scheduled to undergo ceramic implant arthroplasty surgery on 4/28 which is an artificial joint for the 4th & 5th. I will be non-WBing for 2 weeks, then crutches for 3 and PT. I am opting to try this surgery even though using these implants for the foot joints is fairly new rather than fusing those very mobile joints which is permanent, irreversible, and will no-doubt leave me with a very stiff foot. I will post again and let you know the outcome.
I'm not too familiar with prolotherapy. I did do a little research on it, but did not get the feeling that it was used much in my part of the country or that it would be helpful for my problem. Take care and good luck.

thanks for your reply. i am familiar with this new technology and intervention and am very curious as to your outcome. if you decide to go a more conservative route i can make some suggestions as prolotherapy has been helpful in improving cartilage health in my foot, helped reverse plantar fasciitis, reduced some metarsalgia (actually distal plantar faciitis/capsulitis), eliminated some of the hypermobility in the 4th and 5th tarsometatarsal joints in my foot, and probably helped strengthen the lisfranc tendons under 1-3. And it took me a while to embrace the treatment due the mixd feelings the medical community has about (let me just say I am personally acquainted). Also - a very unusual and much higher tech orthotic was much better as I had been overpronating and the middle of my gait had a twist in it called an adductory whip. I only mention this as you may have some of these biomechanical issues that have not been properly recognized which may be contributing substantially to degenerative changes. I have been to 5 different podiatrists, including the chair of UCLA and my own personally designed orthotic was better than any provided me until I found one called the sole support, designed by an ex-mechanical engineer-turned podiatrist (not to overly toot my own horn, but we had similar ideas). I have written about these interventions here and on the boards dot com site - you can review it there if you like.

Did you have a full 5-metatarsal lisfranc and is any of your foot fused? How long ago did you have the injury? (mine's a full foot dislocation and was 8 years ago)? Also - is the surgeon going to do anything about taking off bone spurs - that's currently what I am thinking about doing now as I have spurs that are irritating along the joint and I think limit the mobility, which in the long run I would assume would lead to more progression of the arthritis.

As for your decision, I think maintaining mobility in the two lateral joints is very important - perhaps more than anything else beyond having a stable lisfranc joint, which is primary. Some podiatrists dont seem to grasp that entirely.

Best of luck and feel free to ask me more questions. There is some argument for using proteases such as wobenzyme after a surgery to cut down on the production of scar tissue, as that is among the more bothersome negative effects of surgery that limit a good outcome.

the above was a reply from me - hundredwaters btw....

one other thing... if and when i have a any future foot surgeries i plant on employing something called frequency specific microcurrent to aid in post-surgical healing. i have some experience with this modality (look up frequency specific dot com) and believe it to be somewhat effective - especially in dealing with inflammation. this is different than microcurrent one receives in PT. after my original lisfranc injury 8+ years ago i had a bag of ice on my foot within 20-30 minutes and had it on the entire time in the hospital rather than use hospital old packs. due to aggressively treating the inflammation (i kept my foot elevated for nearly three months, minus 20 hours or so) i had very little swelling for this injury and it healed fairly well - enough so that i was rockclimbing, mountain biking, and doing yoga for many years until i started having problems with plantar fasciitis. getting control of inflammation is fairly important and this technology may be off benefit. (btw - i dont have any financial interest in it...). I havent had much benefit from it just to treat arthritis though - prolotherapy has been more helpful there. Just some suggestions for people having difficulties or planning surgeries.

hi LadyLisfranc - just curious how your surgery went?

Hi Hundredwaters. Surgery went very well. Thanks for asking. Doctor is very pleased with how smooth it went and how it looks 1 week post-op. Another week of non-weight bearing, then sutures removed, boot, crutches, partial weight bearing and start PT. He thinks in the next 4 to 5 weeks I will be back in my sneaker and we should know the results which, hopefully, will mimic the pain relief I got from the diagnostical steroid injection, but will be much longer-lasting.
As to answer a few of your other questions in a previous post, yes I did have a full 5 metatarsal lisfranc. 5 fractures and dislocation of the lisfranc. It happened on 9/17/07. The doctor never talked about bone spurs. To my knowledge I do not have any. A good percentage of lisfranc injuries end up with severe arthritis is what I heard from every doctor I've visited from the very beginning. When it sets in and how fast it progresses differs from case to case. But this doctor/surgeon I have been treating with for 9 months now seems to think that severe post-traumatic arthritis in those joints is what was causing my lingering pain and swelling. So I will post again in a few weeks and let you know how it's going......and if he was right!!

LadyLisfranc with your ceramic implant? Hopefully well! If you get a chance please fill us in....