August 18 2008: Landed awkwardly, felt toe pop. Diagnosed with a bad midfoot sprain. After a few days we realised this was not the case. Finally got in to see an ortho over 2 weeks later, due to insurance problems! Diagnosed with lisfranc sprain/dislocation. Since she was being recruited at this time and all bones in her foot were in line except for the 3mm separation between 1st and second metatarsal the specialist said we could try the non surgical conservative route, although he would prefer to do a fusion surgery.
He said that as a gymnast the fusion would have more success of standing up to the sport. He did not offer her any guarantees that she would be able to do gymnastics again though. We chose the conservative route.
8 weeks in a boot non weightbearing then 6 weeks in boot weight bearing. Then physical therapy and laser therapy. Her foot did improve and she could walk pain free but could not run. Jumping hurt too. After 7 months it began to get worse again!
April 1st 2009: Went back for fusion surgery. 2 screws; one from middle cuneiform to medial cuneiform and the other from medial cuneiform to second metatarsal along with a synthetic bone graft to fill the gap.
6 weeks in a cast non weight bearing then 4 weeks in a boot weight bearing. Weekly visits to our sports chiropractor/kinesiologist for laser and adjustments. Pretty much pain free when walking in the boot. Can point her toes fully again after about 4 days.
Next she was allowed to walk in shoes and barefoot. She had a lot of initial pain as her new foot adjusted to walking properly. She was vigilant with rehab and exercises to strenghthen her foot and ankle and calf. Prior to this she had only had a week off training. This was immediately after surgery. Continued with weekly visits to the chiropractor for laser and adjustments.
Took Ezorb calcium supplements along with vitamin D daily to aid in new bone development.
Walked with a very slight limp for the first three weeks but this disappeared as she focused on walking through the pain.
Swelling was noticeable but not too bad although she did have some days worse than others.
Today it is almost 5 months since her fusion surgery and she SPRINTED!!! for the first time in a year. She said it still hurt but not a lot and was certainly manageable. She can now also do the following:
Rise on her toes
Walk on her toes
She has spent the last month in the gym barefoot for at least 4 hours in a day. This has been 6 hours a day this past week. She has an athletic trainer who massages her foot to break up the scar tissue. She says it feels so much better after this has been done. She still has a way to go to be back into full tumbling and vaulting but the progression is definitely evident. The swelling has been way better these last few weeks. She says her foot is stiff in the mornings and she still has pain over the surgery site but it is definitely improving. She said that often it is discouraging because it seems like such slow progress. It seems like its not getting much better then you suddenly notice one day that it is feeling better. She has not done any heavy pounding activities and there are certain angles that hurt more than others although these are also getting less too. As for walking and jogging she says her foot is fine! So if you are not an athlete fusion is definitely the way to go.
It is still early days yet for a lisfranc fusion, as it is meant to take up to a year to really feel better.
So I encourage you all on your lisfranc journey. A fusion seems to be the way to go especially if you are an athlete. If you have any questions I would be happy to help if I can. All i know is that this injury is a BIG challenge to anyone. Dean from this board was an amazing help for me as my daughter went through the surgery and following months. Thanks Dean!
I hope we can continue to give you good news in the months ahead. My daughter heads off in 3 weeks, to compete for a fantastic college gymnastics team. She will still be rehabbing for a while yet but hopefully she'll be ready to go the following season.
GOOD LUCK, stay positive and stay fit! It certainly aids recovery.
I sufferred this injury to my second metatarcel while playing basketball March 09 (I also tore three ligaments which took three bone fragments with). I had surgery about a week later - three screws - and was on crutches for two months, in a hard cast walking boot for three weeks, and a soft walking boot for another week. Doc said, post boot, lots of cycling to build up strength and green lighted me to start playing basketball again in October.
Needless to say, I've cycled a lot (spinning classes) but the foot is still very sore. Las week I started squatting / leg press / etc. again and even struggled through some pretty intense pain to get my first jog in since the injury. I can walk w/o pain, do toe raisers, and, my favorite milestone, go down the stairs at a decent rate of speed. Still too timid to try one-footed jumps or make any cuts off of it...probably for the better since my calf and other supporting muscles still aren't back to the same size as my "good" side.
I still think October is a lofty goal to be back out on the court, but, again, your daughters recovery is encouraging since it will be about my 6 month point. THanks for the post.
I have noticed several stories here where folks feel helpless DON"T!! Engage your Ortho doctors, the therapist and TELL them what your expectations are and demand they tell you what it might take to get there. Tons of information on the net, ortho sites and physical therapy sites. If I had any suggestion try to find a therapist who will take you to the pool early on, the difference in hydrostatic pressure will prevent clots and your efforts in the pool will be less painful initially. I have been told I will "Never" return to full operational duty for my job in the military, and these same folks were totally surprised when I was swimming over a mile the day after my sutures came out, I am still not running simply because my balance has been so affected by the surgery and the numbness that developed because of nerve damage. I fully expect to be back in Afghanistan next year by summers end. Just because no one ever has done it does not mean I CANT!!!!!
For the young lady who's sister is somewhat resistant to going out, take it slow and feed her ideas. But yes your right she should not sit around and wait for things to get better. They won't improve at all without effort. She will have significant swelling after time vertical and yes the pain is real and it is there most of the time, how she handles it may be dependent on her motivation to get up and moving. This is not a simple injury as silly as a fracture in the foot sounds not so many years ago they just simply amputated these injuries for ease of future life.
To all of you best of luck and here is to your easy recovery!!!!
I had the injury 5 years ago but did not have the fusion. I couldn't stand the pain anymore so I decided to have the fusion. I am really hoping that it is well worth the troubles of so many weeks in a cast.
Szavala - You are going to be freakin miserable for a long time. I was so impatient and thought things should get better right away. It took months just for my foot to stop turning purple when I put it down. I am at the 6-month mark now and I am probably 75-90% better depending on the day and what I've been doing. I see more progress every week. However, that first few months I was really depressed about all the symptoms. Yes, your cast is going to get tight, yes your foot is going to swell, yes you will get purple, you always have to have it up. I've done surgery twice now (the first one botched) and actually my fusion surgery was a faster recovery than the ORIF. Nonetheless, it all lasts much longer than you ever want to imagine. It just sucks. Plain and simple. Here is my story:
I just wanted to add my 2 cents. I had a severe Lisfranc injury with fracture of the 2nd, 3rd, and 4th metatarsals right at the midfoot as well as a fracture of the 5th cuboid on 1/26/11, after sliding in sock feet on our sloped driveway. Foot slid inside sock and folded underneath - toes toward my heel - and I saw the whole thing - sat there on driveway and watched the foot unfold and I said - Oh c**p - you really did it this time! My first broken bones!
About 2 weeks later after swelling went down, I had 1 screw thru #1 & #2 metatarsals to supposedly fix the LIsfranc & then 3 pins to try and stabilize the fractures. The pins backed out on their own and had to be removed 3 months after surgery, and the screw was causing so much pain that it had to be removed 5-6 months after initial surgery. That doc basically botched the surgery! If you want his name...just ask. He does not know how to fix those fractures sufficiently. He is in San Antonio, TX. My comminuted displaced fractures were much too severe and Lisfranc much too severe for such a small surgery.
After screw was removed...over a couple weeks' time my foot started to shift and I had a huge lump on the inside of my foot. Went to a new doctor. He ordered a CT scan and told me that no fractures had healed (after all I had been through nonweightbearing and falling with crutches, etc!!!) and the Lisfranc was a mess, and my whole midfoot was filled with arthritis. Everything was shifting and unstable.
I was referred to a doctor deemed to be the TOP FOOT AND ANKLE SURGEON IN THE WORLD - YES....THE WORLD. His name is Mark Myerson, MD, and he works out of Mercy Hospital in Baltimore. He takes most insurance (if he took mine - he will probably for sure take yours). It is worth the plane ticket. Flew in one morning, preop visit that afternoon, surgery the next morning, back on the plane the next morning. Shuttled around by the hotel people, and I did it all alone. They do make you hire a nurse or an aid or someone to leave the hospital with. They give you a list of agencies to call, and they were all about $20 an hour. I only hired them for 2 hours just to get me out of the hospital and to my room and situated.
On September 13, 2011, so 6 months ago, Dr. Myerson did a midfoot arthrodesis (fusion) with a plate that has 4 screws, plus I have 3 more big screws going through the 1st and 2nd to keep that area held together. The plate screws go through the base of the 2nd and 3rd and through my midfoot itself. I also had about a teaspoon of bone grafted off the top of my heel and put into all of my fractures to help promote healing and fusion. I have about a 4-5 inch vertical scar just left of center on the top of my foot, about a 2 inch scar beside my Achilles tendon where they entered my heel for the graft, and then a couple of screw "cross" cuts on the inside of my foot. That isn't to mention the scars from the first surgery!
For anyone considering arthrodesis (fusion) for a problem such as this, which is what I gather some of you are facing too, I personally think this is the best decision I have made so far. I don't know what my outcome would have been if I had not found Dr. Myerson, but I know my foot was "falling apart." From my midfoot forward, the foot was shifting outward. It was wierd. My friend said as she looked at my feet straight on from sitting in front of me, she said it was like half of my foot was turning out. I couldn't see it as well myself.
Another problem - I was told to take TONS of Advil, Aleve, etc., after I had my first surgery. I must have taken bottles of it for the antiinflammatory effect as well as for pain control. According to Dr. Myerson...YOU SHOULD NOT TAKE THESE NONSTEROIDAL ANTIINFLAMMATORY MEDICATIONS WITH FRACTURES (BREAKS) (i.e., aspirin, ibuprofen, naproxen) (basically, Advil, Motrin, Aleve, etc., etc.). Tylenol is okay. He is extremely generous with the narcotic pain meds because he knows you can't take the over-the-counter stuff, so you don't need to worry about pain. I guess this is a relatively new discovery - that they are finding that ibuprofen and naproxen and other "nonsteroidal antiinflammatory drugs" are PREVENTING BONES FROM HEALING. So if you are on ANY of those - GET OFF OF THEM NOW! If you don't believe me, call Dr. Myerson's office. If you have broken bones now, don't take them!
My internist didn't even know about this new discovery about those over-the-counter meds, so it is probably something that ortho surgeons are finding out first because they are the ones who deal with the bones the most.
Okay - Anyway - Dr. Myerson was also able to remove all of my arthritis in my foot as well. He felt that I would be able to "walk 5 miles again" one day (as if I ever did that before - lol!). The technique that he uses is successful long-term in 93% of patients. I didn't ask him what happens in the other 7%. He did inform me that my previous surgery "just wasn't done properly" and that is one of the reasons my foot didn't heal right. Things just weren't aligned and "fixated" well enough which allowed too much movement. My guess is I was allowed to weightbear much too early as well. Between the ibuprofen and the bad surgery - I was a mess. I had to start over from square one.
With Myerson, I was nonweightbearing for 8 weeks, and then I was in a walking boot for another, I think it was like 43 days. I was then able to come out and go into a good shoe, which I use a good tennis shoe (not a bouncy one...but a firm inner sole...with an arch support inserted that I bought).
Okay - Long story not so short - 6 months after the surgery I am walking around just fine IN SHOES. I will have pain if I am on it TOO long. But just normal everyday stuff - not a huge problem. I have a little pain in my arch here and there off and on - like right at this moment, there is one spot that has a little bit of throbbing pain, but I would say it is like a 2-3 on the pain scale - just annoying. It really varies from day to day and with what I've been doing. I tried to go back to doing hair, but I couldn't handle THAT. Standing for that long on my foot was killer. By the end of my 6-hour days, I was a hurtin' girl. Now I have to do a sit-down job.
I do have a lot of trouble with walking barefoot. It feels like there is a golf ball on the ball of my foot right beneath the big toe. I don't know why. If I rock my foot back and forth on that area, I can feel what feels like tendons shifting across that bone. It is wierd though because the area is no bigger than on the other foot, isn't swollen or anything. It is just ultra sensitive and feels like the bone is bigger. That's the only way I can describe it and I wasn't even injured there. A great deal of the top of my foot is numb, but that came in handy when they took my stitches out - I didn't feel a thing, and they were REALLY embedded in there. You don't notice it unless you touch it though. I have 2 spots that are pretty sensitive if I touch them, but if I leave them alone, they are pretty okay. For a while I wore a gauze pad taped to the top of my foot so my shoe wouldn't irritate that area, but the last couple weeks I've done away with the gauze pads. When I raise my toes up, my 3rd toe lags behind. I have feeling in the 3rd toe when I touch it but I can't make it move. Not a problem - who cares. Doesn't affect anything. Was told this movement "may" come back.
My foot still swells some - very little compared to what it did for several months though (and yes - for months after surgery your foot will turn purple when your foot is down - both surgeries brought that on - doesn't turn purple anymore), and I tend to keep it up at all times (while I am writing this, I have my foot up on a chair). I just tend to think it doesn't swell as much if it is up and it hurts less. It also gets "tense" or "tight". I can't explain it but the whole foot will feel tight sometimes and it will be uncomfortable to try and walk with it tense like that.
Heat definitely helps. If I warm up my foot it is like everything kind of relaxes and feels better. But it is a pain in the butt to always put something on it to warm it up, and of course, it doesn't last.
I had several x-rays for about 3 months because I kept thinking something was "wrong" because of pain and I also fell once, but the last picture taken in December 2011 said everything was healed perfectly. The 4th metatarsal complete fracture was healed so well that they didn't even mention it in the report.
I was told that my hardware will probably not come out unless I have complications. I still limp just a bit, but I think that is more because I lost my insurance (couldn't afford my COBRA payments any longer) and I wasn't able to go to physical therapy, so now I'm so scared of doing anything to hurt it that I am overly careful. However, if I am on a job interview or at a function, I CAN walk without limping. Learned the fist time around in physical therapy that you MUST walk by rolling up over the first metatarsal and onto the big toe or you are not walking properly. Unfortunately, most of us who have this injury end up walking on the outside of the foot. I just read today that that is why they don't put screws in the 4th and 5th when there are fractures. I don't know if that is true or not.
Anyway - I hope this helps. I'm living a pretty normal life. I take hydrocodone with Tylenol once or twice a week just because it makes all the difference in the world if I am going to be on my foot for a longer period of time. If I don't have anything going on that is going to aggravate it, I don't take any medicine.
It rarely hurts if I am completely off of it. In fact, sometimes when I wake up in the morning, I forget that I am not "normal" anymore, and as soon as I step onto the floor, I remember that my life will never be the same :(
However, I do recommend the fusion. I don't think I'd be living the relatively normal life that I am (minus running, hiking, jumping, etc.) if I had not have had it. And overall, I would say the pain is just minimal compared to what I am reading with some people's results.
I think we are stuck with our pain and injuries for the rest of our lives when we have this type. PLEASE CALL DR. MYERSON. It is worth the plane ticket and the 2 nights in the hotel that gives you an amazing discount (across the street). He will also evaluate your MRI/CT/x-rays or whatever and give you a personal phone call and tell you if and what he can do for you. He didn't charge me for doing that. His office staff is the most efficient I have ever worked with. Don't know if you need a referral. You can ask them.
He is hard to get into and I hear it can take months. I kept pressing and kept pressing and kept pressing about needing to get back to my life (I don't have anyone supporting me but myself!) and they ended up getting me in for surgery less than a month after I was told about him. He was amazing. Here is his website:
I hope everyone does well. If you have any info regarding why I feel like I'm walking on a golf ball when I am barefoot but not in shoes... please reply! I sure hope this fusion works. It is 6 months, but every week I think I can see SOME type of improvement - like getting rid of the gauze pads in my shoe. I was told maximum medical improvement can be expected between 6 and 12 months, so I am hoping that a whole lot more improvement happens in the next 6 months.
Thanks, Yes, I didn't mention that I broke it 5 years ago and had a surgery as well. The Dr put 3 screws in but after removing the screws the foot fell and I too looked like I had a huge bump coming out of the side. The arch had completely fell and I was flat footed. I suffered for 5 years because I just thought that was what I had to deal with. I finally went back to the Dr and he couldn't believe that I didn't say anything before then.
I will get my walking cast next week and I am feeling better already this week. I don't take any anti inflamatory drugs, only tylenol. I heard the same thing but my Dr's research said that Smoking was worse for bone healing than anti inflamatory drugs (I don't smoke but just in case some readers do)
Your life sure does change from this injury for sure.
Oh and I too had a feeling like there was a ball in my foot after being on it for a long time. I was hoping this surgery would make that go away.
My Dr will be leaving the screws and plate in it also unless they bother me. I live in Colorado and I know during the winder your foot can get cold from the hardware.
Good luck to you and everyone else out there that has had this unfortunate injury.