BLUF; I sustained my Lisfranc fracture Aug 30, 2012 at a Linkin Park concert. Long story... Went straight to the ER that night, where no one noticed the fracture until just before I left…a radiologist suggested a CT scan. Went to my doc the next week and confirmed the Lisy, went in for the ORIF a week later.
Critical Recovery Components
- RICE (Rest/Ice/Compression/Elevation)
- Exercise (when cleared)
- Stretching/Flexibility (circulation!)
- Massage (pain management/circulation/healing)
--Calcium & Vit D—bone/soft tissue repair (esp after hardware removal)
--B-vitamins—nerve damage repair
- Pain Mgmt—*NO NSAIDS (Ibuprofin/Advil/Naproxen); many recent studies are showing NSAIDs prohibit soft tissue/bone healing
-30 Aug – Lisy fracture
-10 Sept – ORIF Surgery (general anesthesia); 3 screws, 2 horiz/1 vert through 1st metatarsal
-2 wks later, stitches out; talked the doc into letting me go into CAM walker instead of hard cast (so I could wash it and work on flexibility...promised no weight-bearing!)
--NERVE DMG! When I got the stitches out, one of the sutures for the screws was put through a nerve bundle on the top of my foot. When they touched the suture, it felt like a lightning bolt shot through my big toe. I have a VERY high pain threshold, and never imagined a pain like that. My wife gave me a hospital gown to bite down on and I told them to go for it…the most excruciatingly, invigorating experience ever...don’t ever remember a time when I was laughing with tears rolling down my face and shaking all at the same time. This was honestly the worst moment in the journey yet. And water-boarding is torture?!
- 2 wks off/cleared to go to work—opted not to get the scooter and stuck with the crutches—found some great slip on pads and a pouch online (Crutcheze).
-3 wks post ORIF; started PT—recumbent bike 10 mins to loosen up ankle/get blood flowing, ankle rotations, toe crunches with towel. Progressed over two weeks to barefoot weight transitioning to bad foot and calf raises (realized I had Plantar Fascitis at this point).
--Towel rubs and light grit sandpaper on top of foot to stimulate nerve regeneration.
---At Home PT; Put a stool in the shower and massaged foot w/ hot water shower massage and deep tissue hand massage (bottom of foot for plantar fascia and the Lisy itself), ankle rotations/calf raises/toe crunches, finished with more massage, Shower massage on top of foot is great for nerve stimulation.
- 13 wks NWB/on crutches, then moderate WB transition in CAM walker.
- 7 Dec – cleared for weight bearing/transition to shoe—pain around the screw heads and felt a “lump” under the pad of my little toe—suspect that’s possible nerve damage due to initial/sustained swelling, goes away with massage.
-- Once cleared to WB—started “Spinning” (CRUCIAL to my recovery!)
-- Spinning (2-3 Xs wk, progressing from 10 to 30 mins) for Conditioning / Strength / Flexibility / Circulation! Also balanced the muscles in back/legs (relieved back pain due to walking funny/overcompensation on good leg).
*Note—after the 1st spin session, I could finally see vascularity in my foot and it was the 1st time my foot looked normal/not swollen! Increased blood flow in the foot, which has poor circulation to begin with, was critical to supplying blood flow and nutrients to the fracture area for better/faster healing.
**Suggestion—incorporate sprints (light resistance/flexibility/circulation), hills (strength), and slowly build strength to point where you can stand up for single standing rotations, then add time standing with full body-weight & increased resistance. Another huge bene—less chance of hardware breakage due to low impact. I spun aggressively and after 5 months, all 3 screws came out in one piece. I also swam and performed leg extensions/rotations sitting on the side of the pool. Still couldn’t walk normally, even in the pool…
- 14-15 wks post ORIF—Stalled Progress; although my strength/flexibility was building and I worked hard at walking with normal gait, I was convinced I had a tendon rubbing on the screw heads that was preventing me from striking my heel and rolling into a step normally—which led to serious lower back pain and sciatica (relieved with stretching & spinning)
- 10 Feb (5 months post ORIF)—Hardware removed (general anesthesia). I was convinced the hardware was impeding my progress. Although I’m not in a shoe yet and cleared for full WB, when I pull my foot upward and rotate my ankle I no longer feel the pain near the heads of where the (horiz) screws were! Additionally, it seems that I can crunch my toes further and have more overall flexibility/less pain & stiffness. *Note—my doc offered the mini-tightrope, but I declined since the button-head would be in the same spot that the screw head was that was bothering me. At this point, I’m hoping the Lisy healed properly and holds itself together. Tight-rope is a great option, if the hardware doesn’t bother you.
Prescribed percocet after both surgeries, but weaned myself off ASAP…only took once in a while at night for shooting pains, which turned out to be the stitch through the nerve rubbing against the bandages when I stretched/moved. After stitches came out, went cold turkey on all meds. I can more accurately gage my body, injury, and healing if I can “feel” what’s going on. Given percs again post hardware removal but only took the 1st night to sleep.
- Today—foot is still very stiff upon waking and standing after sitting, that’ll take some time to go away. Nerve is still healing, albeit slowly, big toe’s still stiff but getting better. I thank God the new sutures/incisions don’t seem to have hit any of the nerves this time!
- Looking back—I’ve spent countless hours on medical websites and blogs, read all the success and horror stories. In hindsight, if I had to do it over again I’d probably ask for the fusion upfront. I’m VERY active and VERY athletic, trail-running, Cross-fitting, and Power Lifting. Many of the stories I’ve read about athletes getting the “fusion” seem to have the best outcomes. Many of the ORIFs that didn’t heal properly ended up getting a fusion later anyway and cut out the almost guaranteed arthritis from the start. At this point I’m extremely grateful that; 1) I didn’t walk on the foot at all after I injured it, making it worse 2) The docs diagnosed it and got me in for surgery quickly. Only time will tell how well it holds up/how well it healed, but I’m convinced and driven I’ll be 100%...Spartan Run in May?!?! Work in progress, more to come…
Glad I ran into your post. Thank you for chronicling your journey! Our paths are nearly parallel since my injury was July 24, 2012 and had screw removed Dec 14. I've had a custom orthodic for a couple weeks now, but am still reluctant to put my foot through normal range of motion, so I walk with a decided limp. I no longer have the same sharp pain I had when the hardware was in, but it still hurts a lot and I wonder if fusion is inevitable.
What is this "spinning" you talk about? I continue to do some of the exercises I did in physical therapy, but would like to find something more aerobic to do.
Please keep posting. I'll be eager to hear your progress.
Good to hear from you as well! I'm 3 wks past having my screws removed and at first it seemed my recovery would really speed up because the tendon wasn't rubbing against the screw heads and the day I came home from hospital I could rotate my foot much further, pain free. However, in the past couple of weeks I've felt quite a bit of pain in other, new areas of the foot, as well as in the area where the screw heads were. I attribute much of the pain to joints/cartilage moving that hadn't for 5 months, scar tissue and calcium deposits, and tendon/nerve damage healing slowly as expected per the norm.
As far as my PT program, "spinning" is an indoor cycling aerobic class that most gyms offer, anywhere from 45 to 60 mins long (goes quickly w/ good music and good instructor). It incorporates tough hills (strength) and sprints (conditioning). The reason it's so great is that you can go at your own pace, gradually increasing your resistance and standing up only when you're comfortable/strong enough. It works the range of motion, strength in the legs/calves/foot, and greatly increases the circulation of blood in the foot to speed up healing better than any exercise I can think of--best thing is you can get amazing conditioning and strength without any impact! My calf had previously shrunk almost 4 inches after surgery and 12 wks NWB...in just 8 wks (minus the 1 for screw removal) my calf size is almost identical to my "good" leg.
Another must is massage--I massage my foot while under a hot shower (seated on a stool) with soap, focusing on the scar tissue areas and especially the arch/bottom of the foot (helps the plantar fascitis along with the lisfranc ligament). You really have to go deep to get to the lisfranc ligament/scar tissue, I use my knuckles to get it good.
I was hoping I'd be running at least a little by now, but walking is still difficult/painful. I'm sure I will be, just going to take a little more time than originally thought. I've really boned up on a multi vitamin and extra calcium/vit D...
Hope I've given some ideas to help in your recovery, hit me up any time!
Thanks so much for answering!
So the pressure placed on the foot during spinning isn't detrimental? What type of shoes do you wear?
My surgeon told me I should never walk barefoot again-for the rest of my life, with the exception of stepping in and out of shower. Were you given the same advice?
A few decades ago, (I suspect I'm much older than you), I was an avid runner, but became ill with Chronic Fatigue Syndrome and any form of exercise would leave me breathless and exhausted-not the good kind of workout exhausted either. But at least I could walk! Over the years I have regained some stamina, but am looking for a way to get back into an exercise routine that works for the limitations of CFS and now this lisfranc injury. While I was still non weight bearing, I started doing what I could in bed-leg lifts, side raises, etc., then graduated to stretches the physical therapist assigned me.( I added situps but apparently haven't been doing that properly because recently started having pain just below my ribcage, so cut back on those.)
I am focussing on walking with a normal gait and putting my injured foot through its' range of motion. It burns, sometimes during, and often afterward, but I am determined to use that foot properly. My lower back is suffering from limping now!
I haven't tried massaging my foot, but it does seem that could be beneficial. My doctor keeps emphasizing how fragile the foot is, so I've been hesitant. I tried a bit last night, but the bottom of my foot is painful. Are you massaging 'through' the pain?
I too, am taking a multi vitiamin, calcium, vit D and eating calcium-laded foods.
I appreciate you sharing your knowledge and experience and your enthusiasm for staying active in spite of this notoriously ugly injury.
Please stay in touch.
Hello, I'm sorry to hear you too have this injury. After my surgery I too read horrible Lisfranc stories and feared I'd never walk normally again, but not only do I walk, I have full range of motion and less and less pain as time goes by. I just came back in from walking my dog as a matter of fact. I don't go barefoot anymore, I put on shoes as soon as I get out of bed (it's habit now). Much of the time I wear Saucony shoes with orthotics inside, but in the last year I've started wearing other shoes besides trainers (always with orthotics). I found a physical therapist who'd studied feet specifically and she designed orthotics that are much better than those from my podiatrist (who was my surgeon).Yup, it's an adjustment wearing the dreaded "orthotics" -makes you feel old initially, but they help SO much and just become part of life. My best advice is to follow your doctors instructions very, very closely and DO NOT try to rush the healing process, - this isn't an injury you can 'power through.' I've read stories about people who try to and end up reinjuring themselves and prolonging the healing time. It will get better and better. I still do have some pain at times, but it's no worse than a headache. I can't use a treadmill, but I use almost all other gym equipment - weight training and an exercise bike. With the right shoes and orthotics I have a normal gait and even though I can't walk for exercise I walk off and on all day, and don't think all that much about my injury. Take care of yourself - there is life after Lisfranc! Stay in touch.
I don't know if you still check this post but I thought it was worth a try. I sustained a Lisfranc on April 16 during a car accident. Low speed collision but due to the force that I was using in pushing the brake, I broke the 2nd/3rd metatarsal in two places each and split the medial cuneiform in two. I was NWB for 4 months and am now walking and doing physio. I am also a runner and very active. I've been able to weight-train in the gym but have found that I've hit a plateau. (I still have 4 screws in - wires removed at 8 weeks). I still can't do a standing calf raise on my injured foot. I can't seem to get any further increase in flexibility in my toes or foot. I am more sore now on a daily basis than I was before returning to the gym.
I was hoping you might have some feedback on your recovery in terms of stiffness and soreness. The Dr. doesn't want to even consider taking out the hardware until April which limits my ability to get back to running. Any exercises you can recommend?
I would love to hear back from you.
Thanks and glad to hear things went well for you. Gives me hope.
This looks good, guys. I received a Lisfranc from the Lisfranc factory upon sliding on ice and having a head-on collision with a tractor trailer, an estimated closure speed of 80 miles per hour. My Lisfranc was due to my foot being on the brake pedal during the time of the impact. Fortunately, none of the metatarsals were fractured, which helped minimize the amount of hardware I needed during the ORIF procedure. I did have a small avulsion fracture of my cuboid, but that's pennies. The proximal ends (ends closest to me) of the first through the 5th metatarsals of my right foot were all shifted laterally one space, a distance of approximately 10mm, at the tarsometatarsal (Lisfranc) joint. This left the proximal end of my first metatarsal (my big toe) butted up to the distal end of the second cuneiform, and so on, such that the proximal end of my 5th metatarsal was left floating in soft tissue, lateral to my cuboid bone.
Due to the many injuries I sustained from the wreck on 11/27/2014, Thanksgiving Day, the Lisfranc was not discovered until December 8th. Fortunately I had not walked on that foot since the wreck, and I was still in the hospital at the time of this discovery. A surgical podiatrist performed the ORIF a day later, December 9th. The surgeon made two incisions on the dorsal (top) area of my foot, and he used 4 screws to relocate and fixate the dislocated metatarsals at the Lisfranc joint.
Today is 3/5/2015, and I am glad to say that for the past 4 days I have walked around a lake here in town that is approximately 2.5 miles around. The ball of my foot feels as if it has no meat on it due to the inactivity during the past two-and-a-half months that I could not bear any weight on it, so this walking is part of the process of building it back up. In the meantime I have a Dr. Scholles orthotic insole for whatever shoe I wear, which seems to help some. Generally, the stiffer the sole of the shoe I'm wearing, the more comfortable walking is. The doctor cleared me to begin walking in a regular shoe straight from the Aircast (a type of orthotic boot). I will say that pain has been minimal. The trauma surgeon who has been looking after me said that 90% of how well a Lisfranc heals depends on the quality of the surgery. This is why I think it is extremely important to find a great surgical podiatrist to work on a Lisfranc dislocation/fracture, particularly if it is a more complicated Lisfranc injury. I've noticed a minor flattening of my arch, which I do not notice while walking. Swelling is still commonplace, which is probably partly due to the bimalleolar fracture I sustained during the accident as well. I wear a compression sock, though not all the time, and I prefer to ice the foot and ankle region after these walks, even if I do not feel that they are necessary.
Lastly, I pray that all of you have nice recoveries, and that everyone takes it easy while they continue healing.
I'm glad to hear of your progress! I agree that it is vital to find a good surgeon, worth doing some fast and furious investigating immediately post-injury.
You might want to consider having custom orthotics made to further protect your foot. The standard orthotics my surgeon gave me did not provide the support of those made by a physical therapist who specialized in foot mechanics.
My best to you!
i had the same surgery, i´m from Brazil. Its been 3 weeks since i had the knowing about going to surgery and 2 weeks since i had done the surgery. Today when they wen to take the stitches out i had a nerve damage as well and the pain is liking getting shoot i imagine. I have never felt something like that!! How long does it take to go away? i also screamed at the hospital and my wife also helped me a lot. The pain comes and goes, but i was fine? How is your foot today? I will be NWB for 2 months and a half and then going to air cast to starting WB.How is your life today? im very sporstist as im 32 and i broke it doing wakeboardind. its a terrible thing Lisfranc and i thing only us understand each other. Please answer me about everything! the nerve is worring me because the pain is hard!