Lisfranc Foot Fracture Stories-part 2

SD,
Thanks for your reply...glad to hear things are going okay for you! That's a long time to be out of work. I know you must be stir crazy! Well, we saw Dr. on Friday and got CT results. CT found two more fractures, so report was as follows:
-transverse fracture of the base of the second metatarsal
a comminuted fracture of the base of the third metatarsal extending to the articulation w/ the fourth metatarsal base
-intra-articulatar fracture of base of 1st metatarsal medial inferior margin w/ slight displacement of the articular surface with the medial cuneiform
-intra-articular fracture of the first proximal phalanx base which extends to the articular surface

There was no verbiage regarding soft tissue damage or Lisfranc information. Dr. did not seem concerned w/ the 1st metatarsal injury and big toe injury, even though these were new on the CT scan (did not show up on the original X-ray. I am thinking both of those would be of more concern than the original known injuries, since both are intraarticular? He said he did not see indication of Lisfranc injury based on the CT scan, and that husband will do fine. Put him in a walking boot (donjoy low boot) and told him to use crutches w/ very limited weight bearing for three weeks (weight bearing w/ the crutches), then gradually wean off crutches after three weeks and continue to use the boot for walking. HE is to return in 6 weeks for new xrays. Told him it would be 3 to 6 months before return to full activity. Gave him okay to keep working (even w/ his travel requirements and necessity to walk around jobsite everyday), and permission to remove boot for showering, sleeping (?), etc. No other instructions to elevate, ice, keep boot on while sleeping, etc.!

So..I am still wondering if this is the right course of treatment. I am concerned that w/ the extent of other fractures found, especially the intra-articular 1st metatarsal fracture w/ slight displacement, he needs more agressive treatment and complete non-weightbearing?

Husband does not feel he needs a 2nd opinion..this Dr. has a good reputation and graduated from Duke and has 30 years experience, etc. Also, he has very little to no pain in the foot at all at this point (or so he says!) and thinks all will heal just fine in time.

I guess I'm asking if anyone else thinks this sounds like a good plan? He is now exactly 2 weeks post-injury...everything I've read seems to say that the bruising on the sole of the foot under the arch is a strong indicator of at least a grade 2 Lisfranc sprain (not to mention the fractures!), and requires non-weightbearing and cast for 6 weeks at least! Also, w/ multiple metatarsal fractures, there is more chance for them becoming displaced even if stable. The Dr. didn't even suggest mid-term xrays to check for movement.

Any input or suggestions on whether i need to convince him to get a 2nd opinion? We have lots of great ortho dr.'s in our area..don't want to cause issues w/ our relationship w/ this one, but just to be sure....husband is a triathlete and needs to have full function of that foot eventually!

Thanks,

lgrem,
I would suggest a second opinion. I have learned so much about the foot this past 6 months and if I had it to do over again I would have gone to this site and chose 2 doctors and would have saw both of them. If they agreed on a course of treatment I would continue if not then see a third. I have learned the hard way that the foot is very unforgiving. Good luck to you and your husband.
HTH
Christy

**edited by moderator**

Thanks, Christy....we really got fortunate and were able to get him in w/ a very reputable ortho surgeon this coming week! He's a consultant to several NFL teams and the assistant physician to the local NFL football team, so am sure he will have knowledge of if not experience w/ this type of injury...still praying it's not Lisfranc, since the current Doc he's seeing said he didn't see that on the CT scan.

The foot looks alot better already (bruising is gone 2 weeks post injury), and swelling only on some evenings (but still pretty severe when it does swell). Still, husband says he would easily be able to use just the boot right now w/ little pain. :O Fortunately, he's following orders and still using the crutches. This small amount of discomfort still amazes me w/ four fractures and whatever soft tissue injuries there are! (I know SD said he had similar situation, though--w/ little pain!) He's still taking the boot off at night and changing over to the ortho shoe to drive.

Since he's doing so well, we'll just keep our fingers crossed for the same positive plan / dx from this doc as from the 1st! I guess if we get conflicting opinions, we'll have to do as you suggest and get a 3rd. This is just so confusing...there's so much info out there

Good luck to you as you continue to heal, and also to you, SD!

Thanks again for all your help! will let you know what we find out.

Hi all, I posted back in late 2006 after suffering and injury from a ladder fall. I had screws and pins with removal at the end. I have returned to work and I have been working out regularly. Everyone knows when my foot is hurting because I will walk with a limb. My foot has gradually been getting worse over the last year and the midfoot bones have started to deform from the arthritis. I visited my doctor last week and we have decided to go the fusion route. I am scheduled for surgery Oct. 3. I wil be 8 weeks non weight bearing again. All the research I have done states that fusion is your best option from the beginning. I wish I had know that in the beginning because that is what i would have done instead of doing this twice. This board is a nice way to vent, I have even given it to my docotr and he has passed it on to his other Lisfranc patients. I will post back after the surgery. Oh and by the way I read on another message board about a pump for pain medication for the first three days after surgery, they insert it into your leg and you pull it out at home when its done. Everyone that has had it saids to get it if your having this type of surgery. I'm getting one I'll let you know have it is.

TGRW,
are you going to have a bone graft with your fusion? I have to have a graft. one doctor says, "Synthetic bone graft." The other says, "Auto- bone graft." Has anyone had a auto graph? I have to deside and I am afraid to make the wrong decision.
Thanks

My doctor is using synthetic bone if it is necessary. He said he has been using synthetic bone the last couple years and has had excellent results.
I've read that autobone grafts are the use of your own bone material which I think is usually taken from your hip or knee. My doctor said he prefers not to have to make another incision so I wouldn't have two sites healing instead of one and i like that idea better. I've gone through this once already with just the screws and pins and its a long slow process the less pain I have to deal with the better. Hope this helps!

I had my left foot fused one year after a Lisfranc injury was not fixed properly the first time. My foot bones have been fused now for about a year and a half. I had the synthetic bone material used during my fusion procedure and not have had any problems. Your doctor will take several follow up X-rays a couple of weeks after the procedure that will show how well the graft take.

Hi everyone, I'm back to give you an update and provide you with some more information that may help.

I broke my 2nd, 3rd, 4th bones in Feb/2006. I have had no surgery. Found out 1 year later I had a dislocated bone from a different Dr. Urghhhh..... I'm still in pain but it is getting better. My daughter said to me the other day, 'Mom, your foot is getting better because you couldn't wear those slippers last year on a daily basis." Hooray. I've been hiking up mountains and riding the chairlifts down because the foot doesn't like going down hills or stairs but that will be what I work on over the next year. I highly recommend doing ballet exercises, which I believe I posted about earlier (a lonnnnng time ago) and keep stretching the foot out because if the pain continues it becomes permanent (from what I've learned online). Anyhow, here is a website that gives a picture of the exercises (although it would be helpful to find someone to give you a demo). I recommend the Grand-Plie and the Demi-Plie in Positions 1 to 5. I hope this makes sense. I believe I gave an elaborate description in an earlier post.

There is a homeopathic pain treatment that you can use in addition to all the others meds or instead of them depending on the amount of pain. It might help with the extreme pain as it reduces inflamation and swelling. Anyhow, I HIGHLY GIVE IT MY BLESSING, and I use it at night when my foot gets really bad. I start the next day out okay, and then the foot gets more sore as the day proceeds but the pain gradually diminishes over the next week. The Traumeel Ear Drops work like a charm for ear aches. Anyhow, enough about pain, here is information on the product:

http://www.1800petmeds.com/Traumeel+Ointment-prod238158.html

Another thing that you might look in to is, allergies. Allergies will aggravate arthritis and any inflamation that you get in the body and try to avoid them. Its difficult but can be very helpful.

I wish everyone the best and lots of pain-free days in the future.

Cheers, Kelly

Fusion- how is your foot now? I have read that 92% of fusion patients return to normal function and 8 out of 10 are pain free. Do you still have pain? Have you returned to your normal activities? I lift weights but there are some lifts I can't do because it bothers my foot. I also like to spend 30 to 45 minutes on an elliptical, so I am hoping to return to this when all is said and done. I had a heart attack and a by pass 10 months before my injury so exericse is important to me. Needless to say 2006 was not a good year for me.

TGRW, I am 42 years old and I too am a weight lifter, and had been doing it for about 9 years before my car accident in Jan 2006, when I broke my leg and got my Lisfranc as well. When I had my lisfranc first repaired it did not set right and I had a lot of arthritis pain and couild not lift weights either. So I decided one year later (Jan 2007) to have the foot fused. Best decision I could have made. At first when you have it done you may feel funny trying to walk on a foot that has no give in the arch. Your ankle will pick up some of that movement. I would say that I am probably one of those 8 out of 10 people now that is pain free. It takes a few months to get there but I could not deal with the pain I had prior. I got back into weight lifting about one year after having my foot fused. The only exercise you will not be able to do, or do well, is calf exercises on that fused foot. There some exercises I still can not do but that is knee trouble from my broken leg and not related to the lisfranc injury. I see you are from PA, as I am too but I am outside of Philly area.

It will suck having to go off that foot again for another 3 months but in the long run I think you will be better off when it is all said and done.

My doctor is talking about a bone graft taken from my calf and fusing 2 joints. I'm still going for another opinion. 3 docs have told me I need a fusion but everyone seems to want to go about it a different way. Any feedback. I had a tight rope procedure about 18 months ago and still have ongoing pain. The button is starting to cut into my bone and the rope is loosening.

Hello. FUSION if your out there email me **** I want to pick your brain about fusion. I'm only 35 and still cant walk without pain 6 months post op.

This topic is being closed due to having too many posts.

Please continue posting within the following one: Lisfranc Foot Fracture Stories – part 3