Lisfranc injury, NO surgery

Wow that sounds awful . It's hard to believe you would have had a lis franc fracture and not even know something was wrong. It was extremely painful to me. My update is I'm at 13 weeks and finally got my orthotics insoles this week. Not what I expected. I thought the were supportive and comfy but I guess you have to break them in you only wear an hr the first day and increase an hr each day until the second week and then you can wear them all the time. My foot has hurt more since wearing them but they say that's normal . My limp is still very noticeable . If it doesn't improve a lot by next appointment I will be starting physical therapy. When I asked about it they just told me to try towel stretches , towel crutches w my toes , and trace alphabet with my foot . I hope my recovery won't be behind since I've done not pt and they didn't even give me a hand out or suggest until I asked . Not sure how often or many if anyone knows that would be great. Sorry I sound frustrated busy week and limping around has been bumming me out . I'm still so thankful cuz I know it could be worse. I have some pain nothing to bad I wouldn't say I'm in pain . If that makes sense. Praying speedy recovery for everyone.

I'm really surprised you were not suggested PT. After 7 weeks of NWB walking to me feels incredibly awkward and it's not something i'm going to jump straight into. I had a 3 week transition from NWB to WB in the boot. This week I had my first two PT sessions and am making another sloooow transition from boot to shoe. I'm still far (very far) from being 100% but I feel a dramatic difference from when I first weighted the boot 3 weeks ago and now. I feel almost no pain when walking in the boot at this point. The shoe still causes some pain (though not as bad as before) and the atrophy is just plain silly without the support of the boot. That's why I'm only moving forward based on how it feels. I don't feel good about going straight into a shoe yet.

I have a moderately reputable PT in LA and the first session consisted of assessment, measure atrophy, see what hurt and what didnt (I discovered there to avoid tippy toes at all costs!), some massaging and electro therapy. Second session was more massaging, mobility and electro therapy.

Not sure if a single thing did it, but the combination of a slow transition to walking, still trying to stay off my feet and the physical therapy have worked wonders in terms of weight bearing comfort. This is very reassuring as I was freaking out when I first started weight bearing. Foot still feels funny but i'll just have to keep trying then re-assess in 2 weeks when I have my next follow up with the ortho.

That's great to hear its moving in the right direction! A slow transition to weight bearing and PT definitely seems the right call.

I just had a 2nd opinion on my diagnosis/treatment plan from a doc that has studied and spoken about lisfranc to other physicians, here are a few of his thoughts:

- many docs these days go straight to fusion as it offers a reliable result, but you're giving up on a natural working foot

- casting 3 months late definitely still has value

- 10 weeks should be the maximum cast duration (my timing will likely approach the maximum because I received a couple cortisone shots before diagnosis that delay healing)

- after cast comes off, I should stay non-weight bearing for at least a month, and start PT to move the ankle but not flex the foot. It's not unusual for it to still hurt for awhile.

- with increasing usage, he suggested as an evening routine: ice/heat/ice/heat/ice

- once I start walking, to use orthotics, and strongly consider using forever

- I should expect up to 3 years for maximum recovery, which will be about 80%


I'm feeling ok with the long period of NWB, I've been imagining that for a couple months. But the long period to max recovery was disappointing.

I'd been picturing a bit more than a year, but now that sounds like the timeline to be comfortably walking, and it’s a bit longer to become highly active again.


(About my foot: my lisfranc diagnosis came well after the injury, and I am 2 weeks into a cast that started 3 months from the event. With that delay and small or no displacement, surgery was not recommended.)

Man, thanks for sharing the findings. Looks like we have very similar situations. Did the second opinion also agree on the no surgery approach? Are you in a hard or removable cast? Did you ever get an MRI done?

The 2nd opinion did agree on no surgery. Given my long term goals, and preference towards a longer but fuller recovery, a natural foot is worth a try for me. (though this would have been debatable 3 months ago! probably not a fusion to start, but screws perhaps. side note: you can get screws that dissolve, avoiding the removal surgery! Ask for that!)

I'm in a fiberglass cast that covers most of my calf. I did have an MRI, and while I have 8 things on the report, the meaningful item is the lisfranc issue at the 1st/2nd metatarsal. It appears that the ligament is not completely disconnected, and there's no flecking. Thats less serious than a lot of other lisfrancs, so while that probably makes it easier for me to recover without surgery, I don't know that my overall recovery time will be faster.

Very interesting. It does sound like your injury may be worse than mine. How long after injury did you get your MRI? Mine was 2 months later but said lisfranc ligament was "grossly intact" and just reported significant marrow edema at the base of the 2nd metatarsal, bone fragments at the base of 2nd and minor soft tissue edema between base of 1st and 2nd.



Your point is very valid about maintaining a natural foot long term vs possibly shorter term recovery with fusion. It's a tough call but time will tell. When this first happened I thought any time away from sports was a huge loss but after 4 months of doing absolutely nothing i've come to realize that if I can just walk and be relatively normal (even away from sports), waiting that year or two for an answer won't be the end of the world.



Progress report: Most of the pain from weighting the ball of the foot or inner foot is gone (my original symptoms pre-treatment) but there definitely seems to be an issue with the springing in my foot when attempting a normal gait if I test with a shoe. I'll be curious to hear how your weight bearing process goes. There's so much anticipation and nerves for the moment you first step down on how it will feel.

My MRI was 2 months in as well. I didn't get much specific ligament detail or classification other than it was consistent with lisfranc. Well, that and serious edema in the 1st/2nd metatarsals, all the cuneiforms and the cuboid and a few more minor things. Maybe a long list, but I'm hearing that the lisfranc is the only thing to worry about long term.

I'm trying not to focus on weight bearing yet, its just so far away for me. However, I did read that some PT people get you walking in a pool in chest deep water as you start bearing weight, so that is something I'm planning to arrange.

Get a Netflix account and the time will pass quickly :) The NWB time is tough but it'll be over before you know it. My only regret during the NWB period is spending too much time seated at my desk or in bed without my foot elevated. Since beginning to keep it elevated regularly the weight bearing periods have felt a lot better.


Definitely glad to be nearing the home stretch (sorta) and now just hoping it is indeed 100% stable and will heal itself with time. The 2 orthos agreed it was based on the WB X-rays but both of my feet have some weird natural variations as it is. According to the ortho I went with, my injured foot looks more stable and natural than my other one. What i'd do for some pre-injury side by side x-rays!!! haha


Best of luck to everyone, i'll post updates as I progress (or regress).

Well the past couple of days it seems like my limp is improving a lot. I guess the orthotics is really helping now. It's been about 3 and half months since my injury . It seem like my last post went through but I guess that's good since I was having a frustrating week. I haven't done any of the home exercises but it seems like I'm walking much more normal and still no pain. I'm still so glad I didn't do the surgery . I'm very thankful for all the prayers for a complete healing. I want everyone to know there can be good outcomes . Praying for a fast recovery for everyone. Janet hope all is going good with you .

Hi Jeanette! Glad you're doing well! Since I'm 8wks now I guess I'm gonna start exercising my foot more. My toes were getting some shooting pains in them last night. I think I must have let them tighten up or something or maybe it's just nerves growing back. I have some company so I'll probably get more serious when they leave! I'll have to ask the doc about those orthotics. The Rockers I wear for walking have a lot or arch support but don't think I'll be able to put them on the foot for who knows how long. Trying not to focus on how long this takes!!!! :)

Update after 5 weeks in a cast.

Doc originally thought I should return after 3 weeks for new cast, but it still felt snug so I put it off.

Within the past week, it feels like the swelling in my foot has finally reduced a bit (4 months after injury!) and combined with atrophy in my calf, the cast was too loose, and uncomfortable.

I sometimes still feel a bit of very sharp pain at the lisfranc joint, right at the top of the arch on the inside of my food.  I can cause this pain by wiggling my toes a lot, or at times when moving around in bed while trying to sleep.

I also recently started feeling a tightening/cramping feeling in the foot - in a good way. It occurs more frequently when foot is elevated for longer periods.  Doc says this is good.  And my big toe and 2nd toe are not as far apart as they had been.

They removed the cast, and gently squeezed that tender part of the joint.  What was previously a 9/10 pain a couple months ago is now about a 2/10 or 3/10. 

Maybe the best possible news, and really the first sign of healing in months!

Doc thinks 3 more weeks in cast (8 weeks total) and then starting to put foot on ground, and working towards 3 point walking with crutches.

Previously they'd expected another month of non-weight bearing after the cast comes off, so this is a month earlier than expected. Of course, its all dependent on how much of this pain I feel as I start walking.

Thats awesome news Stearno! You must be thrilled. Does your doctor have a lot of experience with these injuries? Do keep us posted on your progress. Im curious to see how it relates to mine.

I was going to wait for the official 5 month anniversary of my injury for an update (January 3rd) but i'll chime in now too.

After NWB period:

My injury actually felt worse after being NWB for 7 weeks than before starting treatment. I was freaked out that it wasn't going to heal and there may be instability that wasn't clear in the X-rays. The doctor insisted I slowly continue to weight it and start with PT. From when I was given the green light to bear weight, it was about a 3 week process from NWB to weight-bearing in boot, then about another 2 week transition from boot to shoe. I just did it based on how it felt which is what the doctor suggested. The more I weighted it, the better it kept feeling!

Physical Therapy:

I am now in my 5th week of twice a week PT and walking entirely in a shoe. I've followed the at home mobility, stretching and strengthening instructions vigorously and progress in the last 5 weeks has been incredible. My walking gait is almost entirely normal again, standing with even weight distribution feels 100%, and weighting different parts of the foot feel much better now too (tip toeing was a big issue before, specially after freshly coming out of the boot). Now that I can tip toe, I am working on strengthening the calf (my atrophy was pretty bad). The stronger the calf, the less the midfoot has to work, but it's sort of a catch 22 because calf exercises heavily involve a healthy lisfranc joint! I've been using a leg press to do toe raises and find the exact maximum my injured foot can take since my body weight is still too much and it's hard not to cheat myself when I try to do toe raises on both feet.

Really the only noticeable things as of now are muscle weakness, stiffness around the ankle (not injury related, just from that NWB period) and midfoot pain on sudden contractions such as quick toe offs when walking or if I suddenly un-weight my foot (like if I were to try and jump). But this is also getting better each week.

Outlook:

Im still taking it very easy but thrilled on the progress. Honestly, running and jumping still seem worlds away but everything else seems relatively soon at this rate. I feel I could probably walk/hike a couple miles comfortably right now (but wont until im further into recovery of course). Most importantly, feeling good ill be able to surf and snowboard in the next month. I mainly just want to build some strength before resuming any of my activities so that i dont go on and hurt something else from all this atrophy!

I gotta say its incredible how long it takes just to recover from those months of immobility, aside from the injury.

Orthotics:

I saw the doctor when I was just starting to walk in a shoe so there was a lot of awkward aches and pains that I didn't realize would go away shortly after. She said it was entirely up to me but that an orthotic might help with shoe walking since I do have high arches. Basically just a temporary thing while I continued to heal and to serve as a bridge between boot and shoe, for the next few months. I appreciated her honesty that it was a high price for very minimal impact (unless you have seriously deformed feet, which I dont). I wanted everything on my side so I pulled the trigger and got some $500 orthotics... With or without the orthotics, walking in shoes got so much better over the next 2 weeks that I dont think I really needed them. Walking in them doesnt really feel any better.

Happy New Years to all you Lisfrancers! Keep the hopes up!

Hi Jeanette and nonsurgicals I'll be 12wks tomorrow post injury NWB. A couple weeks ago I started using an exercise bike but did not like how my foot felt, so I put it off. Then 10 days ago I got a portable ultrasound machine in the mail ($55). I've been using it everyday. In the last 4 days, I realized I can now put my foot in my rocker sneaker without pain and also can do the exercise bike for as long as I like in my boot. The swelling in my forefoot and toes seems to be relaxing. I really like Epsom salt soaks but it's a pain to get the water so I don't do it as much as I'd like but I got a heating pad and have been putting it on my feet at night when I watch a show and strangely, I also think that might also be helping. I'm just going to be slowly adding weight and probably not going to cause my self pain until the 4 mo, mark. I will be adding more weight though before my next xrays on the 28th. Hope your walking is going smooth Jeanette!

6 month update, 4 months since receiving treatment for a stable lisfranc injury (or sprain).

Foot feels about 80-90% now. Fortunately things continue to imrpove; I can comfortably weight all parts of the foot, can toe raise body weight using only injured foot, and can even jump. What persists is a faint discomfort on push off when walking. So while running still feels out of the question, I am back training in the gym and intend to get back to most things (surf, climb, snowboard) in the next few weeks now that ive recovered much of the strength I lost from being gimp for 5 months.

Physical therapy had a huge impact coming out of the boot and returning to activity. I plateaued after 4-6 weeks of therapy and the doctor says it can take around a year for it to go from this point to feeling normal. 

Hope everyone else is also making good progress. 

Coon, I read your email at 3am last night, finally someone who has something similar to my situation. I have a milder injury, but I still cannot walk due to sharp pain in my mid-foot. Unfortunately, I did not push back hard enough and this has been going on too long. I've been to two of the top orthopedic surgeons in my area. One did not tell me what was wrong at all, just kept saying I could do whatever I want. (no displacement, MRI clean, but no CT scan was done). I notice that yours was detected with the CT scan. When I kept coming back unable to walk more than short distances by leaning on the side of my foot, he ordered orthotics and said he could fuse joints. I went to a second ortho doc (board certified, best list in my city) he said I'm fine, that I had a Lisfranc injury with no displacement and I just need physical therapy, which I started the same day. He did not do a standing xray, it was done lying down. PT was extremely mild and after seeing my pain from standing on the foot, she sent me out with instructions to use a crutch to walk with less weight bearing. The pain after this PT visit was horrible, and anti-inflamatories, ice, did not reduce it, finally I started researching Lisfranc. I was never in a cast, and other than the first week, was never told to be non-weight bearing. How do I find a doctor for this? The second doc says it IS a Lisfranc injury (now I'm getting arthritis and my arch is lower), but does not do the Lisfranc tests, and the first doc kept telling me I'm fine, but I can't walk. Both are board certified ortho foot and ankle surgeons. I am a researcher, so I have to spend a lot of time sitting for my job, and I can only limp around the house otherwise. Thank you so much to everyone who has shared their story here, it has helped me understand what this is. I have to find a doctor and a physical therapist that understand this injury - I want to walk again.