Hi Kaily,
When did your injury happen? What specific foot motions hurt the most? From what I understand standing X-rays are the only way to see if there is displacement. A weight bearing foot is totally different than a non-weight bearing foot. My doctor checked a top view to see if there was side to side displacement, then a side view to see if there was up down displacement. After my standing X-rays looked suspicious, we got a CT which saw bone fragments, it turns out these are from the ligament partially tearing off, further supporting a Lisfranc injury. Finally the doctor ordered an MRI to see the severity and whether the bone fragments would need to be removed.
In my experience (now over 6 months since injury) do not be relieved that you just have a "mild" injury. My doctor says recovery time is about the same if you operate or dont (assuming its stable). It's just a bad injury to have because its so crucial to being on your feet and afterall we are bipeds.
What I ended up doing was researching all the best foot orthos in LA, then seeing which worked with my insurance and eliminated the ones that didn't. Then I got 3 opinions because the first 2 didnt agree.
In hindsight, it seems like the best way to have treated mine would have been to pin it right away just to make sure it healed 100% correctly. But 2 months late and being a "mild" injury, that wasn't going to do much.
Hi Coon, thanks for your reply and all the details you provide. My injury happened 12/26/2013, so it’s been 13 months - I hope not so long that it won’t get better. I was on a curb and stepped back one step with my left foot, not realizing there was a steep handicapped ramp behind me. I landed on the heel of my high heel most likely but I only remember landing on my back at the bottom of the 1 ft ramp. It was sore on the top and bottom of my foot, swollen, I hoped it was just a sprain, but went to the ER the next day because the overnight pain was unbelievable. I have learned so much since Tuesday (2/3/15) when the second doc told finally me what this is and it seems you are right, that no matter how mild, if it doesn’t heal I can’t move forward, as evidenced by the fact I still can’t walk straight or further than around the house. I have sharp midfoot pain in different places, especially on hard surfaces or more than around the house, feels unstable, can't get a "normal" step, so I walk on the outside of my left foot which now hurts my ankle. Actually, I think the mild ones are worse because they don’t get treated.
After the official diagnosis by the 2nd doc and the awful PT experience, I looked online and read as much as I could. I decided to stay completely off of the foot, and still have the ‘boot’ the first doc gave me (although he gave me no instructions with it), so I’m wearing that NWB until I can find a doc who seems to understand this, or at least go back to the second doc next week and ask a ton of questions, starting with why he didn’t use a WB xray. The protocol on almost every authoritative website is pretty much identical: WB xray, MRI, CT or bone scan to diagnose, treatment 6wk NWB, transition to WB, PT…. just not what my doctors seem to be doing. Posts from people following the protocol say they seem to be improving, but I’m not.
I am willing to travel a long way to get to a good doctor and physical therapist (yours sounds wonderful!) but it seems like the injury is so uncommon that not all Foot Ankle Orthos do much work with it. I’m in Ohio, not near LA.
I hope you continue to improve. If I can get some improvement after 13 months, maybe I’ll give everyone some encouragement to keep at it. I am incredibly thankful for this site and am anxious to hear the follow up on everyone.
Sorry to hear so much time has passed, mine was magnified by only a 2 month delay in treatment, I can only imagine 13 months. From what I understand, after a certain point fusion is the only option. My doctor didn't make it sound too bad and said it would be her best suggestion if mine didn't improve with treatment (after only 4-5 months since injury, knowing my priority was swift recovery). She basically said if the joint is causing you pain and you eliminate the joint, the pain should be gone. Also that the joint does not have a ton of motion so it's something you can get used to relatively quicker than fusing other more mobile joints in your body. She placed a big emphasis on whether it was getting better or worse with time. Unstable joints only get worse and stable get better and you let them be.
However, obviously this only applies if it's the lisfranc joint that is causing you problems and that is going to take a good foot ortho to know with 100% certainty. I'm sure theres a boatload of other injuries it could possibly be that might be more "fixable". You definitely don't want a fused foot if it's not going to help.
In my case my pain became very concentrated with time. At first it was general midfoot, then it became concentrated to only the base of the second metatarsal so the specific damaged area was evident. Luckily it sloooooowly continues to improve, so talk about fusion has ceased.
Coon, thanks for sharing your doctor's comments, it's helping me know what questions I should be asking. Slow improvement is definitely on the right path! I hope to find a doctor I trust and get to into a slowly improving direction.
6 months post injury - got my cast off a few weeks ago, here's my update:
I had the 1st cast removed at 5 weeks because it became too loose. The 2nd cast was put on immediately, for 3 more weeks. When that came off I could not put much weight on it, and it was still very swollen.
They said I'd be on crutches for a couple weeks gradually getting full weight bearing, but it felt good in a week. I was ok with gentle weight bearing at that point, but the sharp midfoot pain was unchanged.
I started PT with a ballet specific therapist, I figure they know feet. Definitely have strength coming back, have bought some stiff-soled shoes, and can carefully walk short distances and use stairs.
If I walk more than about a block or two, or sit with my feet down for more than a couple hours, I still see a lot of swelling, and it aches. If I walk fast or have only the front part of my foot on a step, the sharp pain is instant, and no different.
While that pain feels the same when it DOES occur, its hard to tell if its triggered less easily. I'm on a routine which doesn't cause the pain, and can walk normally (slowly) without pain. Trying hard to be optimistic that it will lessen over time.
Mostly I am still at home on the couch 85% of the time, and walk around barefoot. I am not considering orthotics, but taping the arch helps limit the sharp pain as I'm increasing my range of motion.
I'm also trying to get the swelling down, so have been doing hot foot soaks, and seem to be having good results with acupuncture, the guy even hooks it up to some low voltage current! I would say my swelling after the cast came off was 75% of its maximum, and after 4 acupuncture sessions, now normally sits at 10-20% of maximum, though it goes up a lot if I overuse it.
After 3 months on the couch, I'm really ready to start being on my feet more, especially with my strength coming back, but the swelling and subsequent ache makes it hard.
My injury profile:
Injured 8/2014, and spent a month limping around. Main complaint is extremely sharp pain on top of the midfoot with a normal gait, but have numerous other painful spots as well.
Month 2, got diagnosed as nerve damage, had a couple cortisone shots. Weight bearing x-rays showed no displacement. Learned later that the shots hinder soft tissue recovery.
Month 3, got a new doc, an MRI, and diagnosis of stable lisfranc + 8 other misc. Was put in walking boot, and it got worse. They said I'd have been recommended surgery if I showed up right after my injury, to ensure stability.
Months 4 and 5 in a NWB cast.
What a difference a week has made! I'm noticeably stronger, and the sharp pain appears to be diminishing and harder to trigger. Swelling is much better too, and I'm able to spend all day sitting at a desk without having to suffer for it.
I still can't walk very far or fast, but am feeling much encouraged.
One thing that has brought me a lot of benefit is taping the arch, it really limits movement of the lisfranc joint without having the discomfort of an orthotic. Particularly since I'm mostly barefoot, this has been an excellent addition.
(2 strips of tape: one from the heel on the sides of the foot to the arch, and another from under the foot, overlapping on top and angling back under the ankle, connected to the first tape strip.)
Great to hear from you again Stearno.
Looking back now all I can say is that youll be really frustrated because improvement is so slow that you just dont really notice it, but eventually youll compare yourself at present day to a specific memory last month and itll hit you. I felt at around 5-6 months I plateaued and thatd more or less be my permanent state. Now at month 7 I look back to my first surf session back, 1 month ago, and just think how much better my foot is today than it was then. I can say that with my increase in activity it has only gotten better and after lots of specific training and therapy I am back to almost all of the pre-injury activities (albeit slightly toned down). Running is the only thing I refuse to try because it's such an extreme mid-foot activity, specially the way I like to run. But I can hike fine (I also now realize how much more comfortable a hike is in the orthotics than plain shoes, I wasn't backing them at first but I am glad I got them now. The must just take getting used to).
What's crazy is that in the last couple weeks it hit me that I might make a full recovery indeed and the revelation has come from continuing to slowly increase activity. Each time I do something, it feels better than before so long as I properly recovered and kept up with the stretch and strengthen routine.
The post-cast period is really hardcore. You will see tremendous strides in the next 1-2 months. Its incredible to think of how my foot felt coming out of the cast vs how it feels now.
How long do you plan to do PT? How often do you go? Sounds like youre doing it right.
I am writing in March 2015. My lisfranc disruption was incorrectly diagnosed as a severe sprain at first in 2014, but after an MRI, when not healing, doc realized it was more serious. Refered to an ortho, but in the meanwhile he had told me to go back to weight bearing in the meanwhile. Not good. I am also under 2mm, hence no surgery. I have been in Jones splints and 2 different fibreglass casts. I just don't seem to be improving at all. December 12 slip on ice put me here. Its now been 3 months and a week. Really worried. Can you give me some hope?
From my experience (2 months walking on it before diagnosed as a "stable" lisfranc injury) the 3 doctors I saw mostly agreed; Non-weight bearing in cast for 6-8 weeks, then weight bearing in boot for 3 weeks, then lots of PT.
Considering yours was diagnosed as a lisfranc injury, I am surprised they have you walking around on it.
For peace of mind, if treated properly this DOES GET BETTER. For months I worried it was never going to heal, but now 7.5 months later, it has improved dramatically. It does still affect me in athletics but i'd say for your average person who is not extremely active, they would be pretty much back to normal.
Thank you so much for this. You have no idea how much this helped. Yes originally after 4 weeks I was started with weight bearing again, although I was protesting, "I think this is more than just a really bad sprain." Finally after 2 months, and me googling "why won't my sprain get better," I came up with the term LisFranc. As it was not getting better, insurance agreed to do an MRI, and what do you know - I was (sadly) right. How do you do partial weight bearing when mastering crutches seems impossible (several falls). I am using a knee scooter for affected leg. I am gaining lots of weight being non-weight bearing. Am going to have to go back to work soon. Thank you for the prospect of hope. Only see ortho docs every 7 weeks, seems like aeons. As deemed non-surgical (thankfully), just got to sit it out, but every so often have to get a weight bearing xray. They see nothing and it sets me back. Thank you again.
This is an update to my earlier post about a long overdue diagnosis of lisfranc injury. I went back to Orthopedic Doc #2 with lots of questions (aided by Coon's info and other online research) and saw a third specialist as well who said the same. Lisfranc injury with about 1mm space between 1st two metatarsals, but no bone displacement (ligament only injury). I have started physical therapy. The doctor says that I should have been sent to therapy earlier to address the lisfranc sprain, and that walking wrong on the foot for so long (around a year now) has caused referred pain and soft tissue problems that compound it. He is also optimistic that pt will help, but emphasized that this is long term recovery and would not speculate on the outcome. After 3 weeks of therapy, I can report that my ability to stand on one foot has improved so I can "recover" from a lean toward my instep, the limp occasionally is gone when I am not tired, and I do 2 foot toe raises in physical therapy now. The news from Stearn and Coon is really encouraging, and I hope to report improvement as well. I also took up aqua-jogging (running in the deep end of the pool) to try to strengthen the supporting leg muscles - I lost a lot of strength over the last 14 months, especially on my left side. And I found some awesome Montrail flip flops with arch support for the locker room. Worriedgal, I hope you get more answers soon! I should have been more persistent when it did not improve.
Great to hear youre making progress! My diagnosis was very similar to yours but it was only 2 months overdue so my doctor decided to treat it as if it were a fresh injury. My ultimate test for the success of PT was going from not being able to do a standing toe raise on the injured foot at all to now doing it fine even with extra weight in my hands. It took about 1.5 months worth of slowly increasing weight to get there.
It sounds like you have a good doctor. These injuries suck and any doctor that is being up front about them being long term and not doing any sugarcoating is just being honest. The last thing you want is someone to get your hopes up and say youll be 100% in 2 months.
You will get better though! Really, my foot mostly just feels unnatural now but doesn't hurt. I can torque it and place weight in all sorts of ways so am able to get on with my life. It's mainly just when i'm walking and thinking about my feet that I notice one is slightly off, but we are talking minimally. I'll still take that over limping and walking on the outside of my foot though!
I really appreciate your post. Though I missed it by 4 months, whoops. So here I am, 5 months post injury. Two MRI's and countless PT sessions later, and my foot is still swollen and definitely not back to normal. I feel pretty much hopeless at this point. The second MRI indicated healing, but very slow healing at that. My Ortho doesn't have any suggestions, nor does my PT. So what the heck!? I've thrown countless dollars and time at this injury, for what seems to be minimal results. My constant worry is that this will be a chronic problem for the rest of my life. Which isn't very ideal given my active lifestyle. More or less, I'm just completely lost. All I have to go on is what my Ortho, D.O., and PT have told me. Which has more or less been incorrect so far. All three were convinced I was going to be good to go by Feb. Clearly not the case.... Frustration doesn't even begin to describe how I feel towards my right foot. So, who's got the magic bullet out there??
Im pretty active myself and my life basically revolves around sports. When a podiatrist suspected the injury I began researching on it, it scared the living hell out of me, particularly reading about the lifelong chronic pain stories and kissing away my lifestyle. So knowing the importance this played to my lifestyle, I saw three foot/ankle orthos that were top notch in my area to get the various opinions. The podiatrist who discovered it (a very active rock climber herself) suggested to play it safe and get it pinned even with minimal displacement (only requires initial surgery, no second surgery to remove hardware) , that it was a very aggressive sure way to treat it since many people go into casts and come out feeling the same, requiring eventual surgery anyways.
So with that in my mind, I was very pushy about surgery with the 3 orthos but none of them agreed about operating on it. So the take home is to get VARIOUS opinions and be pushy about it. I basically told my ortho, "treat me the way you would treat a professional athlete who is being benched and losing money."
Another thing is these do heal very slowly. My doctor said that in the first 2 months my body was aggressively trying to heal itself but I didnt let it by continuing to walk on my foot. After a while your body doesnt think its injured anymore so the healing occurs very slowly. Mine is still healing 8 months later but it continues to feel better and better every month. I thought when they said that it could take 1-2 years to heal, they were just trying to put me down easy but its TRUE. I really think I will be fully healed at the rate im going.