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Hi everyone. It's nice to know there are others in the same boat, but it seems like a sinking ship. A little bit about me...

I'm a 28-year old woman. Lisfranc was diagnosed 3 weeks after a car accident which totalled my car (another driver tried crossing the highway in front of me and I hit her at about 45-50 mph). I was sent to a foot/ankle specialist in Baltimore who said we were lucky it was caught so early. I had surgery 2 days later where he inserted two screws to bring the bones back into line.

I was told my treatment would go as follows:

Surgery to put in screws. Post-op, foot is placed in a brace/splint which is then wrapped in gauze and cotton padding to allow for swelling. On top of everything is a stretchy wrap (akin to VetWrap if you're an animal person). This creates a soft cast which keeps the foot immobile.

I've been told to keep foot elevated for 72 hours and use RICE method. I'm in between this step and the next one but have found that I need to keep my foot elevated or it begins to swell and feel the burning and pins/needles sensation others have talked about.

Two weeks later I return for follow-up and soft cast comes off and is replaced by an ankle brace which will be worn for 4 more weeks (still non-weight bearing)

Six weeks from initial surgery, second surgery to remove screws. Afterwards, I will wear a boot to return to weight-bearing (my husband calls this my Robo-boot). I'm not sure how long I'll be in the robo-boot.

I go for my two week follow-up next Wednesday and my biggest concern at this point is that it seems like everyone else here was told to begin weight-bearing before the screws come out. I wonder if that might be part of what is causing the burning/pins/needles to last? Also, it seems like most of you have had your screws removed several months after they were put in. I wonder if 6 weeks is going to be long enough to make a difference.

Has anyone else had the screws taken out at 6 weeks and then started weight bearing afterwards? What were your results?

Thanks,
Anne

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User avatar
Legend
345 posts
I think dr.lady knows all the answers :-)

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Injuries to the Lisfranc complex are fairly common and difficult for patients.
Delayed treatment or missed diagnosis of these injuries can lead to significant complications. Early diagnosis and orthopedic referral are necessary because operative treatment is often required.

Long-term functional results were better when the quality of the reduction was excellent.
The dislocations were divided based on the classification system its very meter. Your treatment would go if you already know the details like when you have had your screws removed or when you begin weight-bearing depends of the recovery the bone and of the dislocations classification.

A full recovery is at the end of the ninth month, range of motion of the foot and ankle was full, with no pain on daily activities. I wish you best and do not worry.


Dr.lady

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Update:

My husband and I misheard my doctor the first time. After the original cast came off, it was replaced by a fiberglass one. I believe my next visit I get put into a walking boot. The screws will actually stay in until 4 months post surgery. So far, things seem to be going well. The burning/pins & needles stopped once my foot stopped swelling. Hopefully, I'm one of the lucky ones who didn't get long-term nerve damage.

Anne :-)

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I'm now 2 weeks pre-screw removal. I've been weight-bearing with and without the robo-boot. I wear the boot mainly at work (I lift and carry computers all day - there's no way that's happening without the boot). I still have a lot of pain most of the time. Some days it's more of a dull ache. Other days, it's almost a constant burning/searing pain from the nerve rubbing the top of the screws. On a few occasions (sometimes it's just a few minutes), my foot doesn't hurt at all, but that's only when I'm wearing the boot.

I know the more the nerve is agitated, the more likely I'll have long-term nerve damage. I try using the boot as much as possible because it seems to limit the nerve pain. At home, I've always liked to walk barefoot, but have found with the screws in that I'm more comfortable if I walk with shoes on. Concrete KILLS my foot.

I've also developed a bad case of plantar fascitis (sp?). I think I had a little bit of this before the accident, but now it's unbearable in the morning unless I wear the stupid leg brace to bed.

My doctor assures me that I'll feel an immediate relief after the screws come out. At this point I'm more annoyed than anything. I've had knee problems since I was a young teen and since I can't "jog" down stairs with this foot, it's putting a lot of strain on my knees. I take Celebrex and Tylenol to try to control the knee pain, but it doesn't seem to do anything for my foot.

I'll post again after the screw removal to let you know my progress.

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User avatar
Legend
345 posts
Hey Anne,

I wish you good recovery and all the best!

Let us know how was your screw removal.

Good luck!

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Thanks Pseudonim,

This surgery was MUCH easier than the first one! Screws were removed June 17th, it's now the 21st. Not much swelling and can definitely feel a difference ...no more constant ache where the screws were. I do notice some nerve irritation when I walk or move my toes a certain way. It's not constant so I'm hoping it's just because of the little bit of post-op swelling. Actually, my bandage is causing more pain than the screw removal itself at this point because it's rubbing against the skin on my foot as I walk and my job requires a lot of walking.

I know some others have said the same thing, but I want to reiterate for anyone reading this....if you're diagnosed with a Lisfranc fracture, see a foot/ankle orthopaedic specialist immediately! When I went for my pre-op exam with my regular nurse practitioner, she was asking me about how my ordeal has gone. Then she told me a horror story about her own mother having a Lisfranc fracture in 1999 from falling off a ladder. Her mom's regular orthopaedic doc tried fixing it, but now it's 2005 and her mom still has a lot of pain and problems with that foot. This fracture really requires a specialist's attention.

I've been in my walking boot for the last 5 days and tomorrow i'm in a post-op shoe until 2 weeks from screw removal. Also, no getting my leg/foot wet until the 2 weeks is up. Then my doc said I'm good to go (I live about 2 1/2 hours from my specialist so he's letting me remove my two stitches myself at day 14). I'll post again in a few weeks to let everyone know how I'm doing.

Anne :-)

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I am ten weeks post fusion for a Lisfranc injury. I sustained the injury on June 21, but the actual extent of the injury was not discovered until about 8 weeks after the injury - after 2 sets of x-rays, an MRI and a CT scan. At 12 weeks post-injury, September 14, I had a fusion of 1-3 metatarsal joints with bone graft. At one week post-surgery, my cast was removed and I was put back into a cam boot (which I used pre surgery) and started using a bone growth stimulator r/t my physicians concern about the softness of the bones. At 7 weeks, I was permitted to bear weight with the cam boot, and at 8 weeks went into athletic shoes with orthotics. Walking has been very painful with much swelling. A large grape-sized lump appeared on top of one incision area. My physician feels it could be r/t fluid, loosening of some internal sutures or a stress fracture. How common are stress fractures after previous foot injuries? What treatment is usually used? Since being on my foot more- I started back to work this week 4 days ago- I am having increased pain, especially in the outer ankle and side of the foot.

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There are several factors that could contribute to the development of stress fractures but most often, they occur because of a repetitive use injury that exceeds the ability of the bone to repair itself.

Other risks that may contribute to stress fractures are: participation in sports involving running and jumping, rapid increase in physical training program, decreased bone density, nutritional deficiencies, extremes of body size and composition, inappropriate footwear and poor flexibility. Women are more prone to stress fractures, even hormonal and menstrual disturbances may lead to the fractures.

Conservative therapy usually consists of rest, activities are restricted to normal daily and limited walking, NSAI drugs ( like ibuprofen, etc), stretching and flexibility exercises, etc

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Hi -
Hoping someone has some advice on this -

My 70 year old mother has been diagnosed with a Lisfranc injury and is dreading the idea of surgery. Does anyone have any feedback on how they fared without having the screws inserted? Are there any alternative treatments? Does the amount of displacement matter? Hers is very slight - she is now about 6 weeks post-injury and able to get around a bit without using her boot. The idea of being incapacitated again is depressing her.

Thanks in advance.

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Hello there! The amount of displacement certainly matters when deciding upon the treatment. What did the doctors say?

I do understand that your mother may dread the surgery but if that is what it takes-then she should go for it. If Listfranc injuries are not treated on time, they could lead to severe complications.

However, if the displacement is mild like you said, in your mother’s case, then she should do well without a surgery, although some fixation is usually performed.
When is her next appointment to check the progress? I reckon it should be soon. It is usually 6 to 8 weeks after placing a cast.

Careful examination is what she needs and then the doc should decide upon what to do.

Following doctor’s orders is essential. Once again, I would suggest you didn’t play with this and listened careful to the doctor’s order because of the possible complications.

Let me know what the doctor recommended and how the healing goes!

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I HAVE BEEN TRYING TO FIND OUT MORE ABOUT THIS INJURY. SEPT 9TH O5. I HAD A LARGE METAL STOCK CONTAINER FALL ON ME. THANK GOD I WAS NOT CRUSHED, BUT I DID BREAK MY FOOT. AFTER HOSPITAL SENT ME HOME WITH A SO CALLED SPRAIN, I WAS CALLED BACK & SENT TO A DOCTOR & TOLD I HAD 3 BREAKS & IT WAS CALLED A LISFRANC FRATURE. I HAD SURGERY & 2 SCREWS BUT IN. AS OF THIS DATE NO MENTION OF REMOVING SCREWS. I AM HAVING A LOT OF PROBLEMS & WORRY ABOUT LONG TERM CONDITIONS THAT MAY COME FROM THIS. I HAVE READ ABOUT SOMETHING CALLED SUDECKS ATROPHY, DEGENERATIVE ARTHRITIS, & TMT JOINT??? I WAS TOLD BY THE DOCTOR I WILL ALWAYS HAVE A LIMP. I AM SUPPOSE TO BE GOING TO A CHRONIC PAIN SPECIALIST. WILL I BE CONSIDERED DISABLIED?? ANY FEED BACK WOULD HELP WITH MY MENTAL STATE THANK YOU. 8-|

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Hi there.... I had a lisfranc injury in October of '99, and spent a few weeks being told there was not a problem until I self-referred to an orthopedist who diagnosed it. They put in three screws for fixation, and at the time, my doc didn't want to remove the screws.



After a year or two, when the foot was still hurting, and a visible bump was showing through the top of my foot where the head of one of the screws was, I knew I had to have the hardware removed. Unfortunately, I was without health insurance for a few years, and finally had the screws removed 12 days ago. They only removed two of the three, and shaved down some bone that had scarred up around the heads.



I was told my my current Orthopedic Surgeon that I should expect to have some kind of chronic issues with the foot, and probably arthritis in the joint. When I asked "will I ever be able to run again" he said "no" - so... not the best bedside manner, since it made me cry!



The important thing right now, to me, however is to let this heal properly, and keep a positive outlook. I'm determined that I will gain back as much use of this foot as I can.



For you, I'd suggest talking to a surgeon and describing the pain you are having. If you are having hardware pain, and the joint has healed, you should press to have the hardware removed. It'll put you back into "recovery mode" for a few months after that surgery, but ultimately, I've heard that getting the hardware out can make all of the difference in the world. (I'm hoping so!)



Don't wait several years, like I did, to address the problems you are still having. Also, if you need to, see some alternative medical practitioners, such as a homeopath or naturopath, to help with recovery, joint support, or pain management - but don't put off asking for hardware removal if you think the screws are contributing to the pain - especially if you can feel the head of a screw, etc.



The pain specialists should be able to answer any of your questions about sudek's atrophy, but for some people the pain issues, even of things like sudek's, don't last forever! Don't give up hope.



It's really frightening, especially since lisfranc injuries are notoriously difficult to recover from - but do yourself a favor and ask if the hardware could be contributing, and do what you need to do to develop a positive outlook for recovery!

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OK....I've noticed there's been a lot of talk since I last posted here. Let me offer some advice from my own experience....

In the case of the 70-year old mom, I would definitely encourage her to have the surgery. My specialist ended up removing my screws, but he said had I been older (like in this woman's case), he would have left them in. The reason for my encouragement is that, left untreated, a LisFranc fracture will most likely develop severe arthritis in the affected joints.

For the guest who wrote about their injury in Sept '05, a lot depends on your surgeon and your age. My surgeon removed my screws because I'm young and very active, however, he did caution me that after a LisFranc injury, there is a risk of developing arthritis in the affected joints even after surgery. If and/or when this happens, the only treatment at that point is to have the surgery again to reinsert the screws which will fuse the bones together. Granted, I will have a limp, but I won't have the pain of the arthritis in the joints. I feel your pain (quite literally) about the limping. It's amazing how much the foot flexes during normal walking.

Limping for several weeks along with the being off my foot for 9 weeks screwed up my back. I'm still seeing a chiropractor for that, but she's given me a better prognosis on the possibility of developing arthritis in my foot. Because we've been breaking down the scar tissue that built up while my foot was immobilized, I have more flexion and less pain overall.

Like the woman who had her screws removed several years after they were inserted, I too, have a bump on the top of my foot where I assume the screw pushed the bone up. It doesn't cause me any pain except occasionally when my nerve hits it just right. You all know what I'm talking about.

One of the things I wasn't prepared for is the pain and loss of mobility in my first joint in my big toe. Since my injury was with the first and second cuneiforms and first metatarsal, I wasn't able to flex my toe joints until after my screw removal. At that point, my toe joint had been immobilized for about 5 months. It's been almost a year and I have about 90% of my flexion back, but I still have chronic pain in the toe. Strange, since you'd think the pain would be where the initial fracture was. I massage my foot a lot these days and find it helps more than anything else. I also have my chiropractor periodically adjust the joints in my foot which hurts like a SOB when she's doing it but the relief is immediate.

To give everyone a little hope, though, I am now able to jump, run and dance again. I can't do any of them for extended periods, but I'm mostly able to do things I could do before the injury. I find the hardest thing is stooping because of the angle your toes are bent when doing so.

I hope all of you enjoy speedy recoveries and regain the mobility you have lost.

Blessings,
Anne

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Hellllpppppp..... I injured my foot on Feb 20 and am still in a lot of pain while walking with "my foot" as I call it. Has everyone had weight bearing x-rays for diagnosis? I've had numerous regular x-rays and a CT scan for diagnosis. I've worn a cast for 3 weeks and "my foot" for the rest.

Things I know for sure..... 3 year old boys and broken feet do not go well together.

Does the pain eventually die down so that you are able to walk on it or should I just decide to get used to it.

I'm still not functional but doing much better when I compare myself to 2 months ago.

Any experience you can share with me would be appreciated.

Cheers everyone, Kelly

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