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Hello all
I need some advice from anyone who has any experience of mid foot fusion surgery.
I had a lisfranc injury 3 years ago which was missed and i have encountered several incompetent doctors and no treatment i have had has helped. I cannot walk very far and am pretty much always in pain. My new doctor, an orthopaedic surgeon, has told me that the only treatment i can have now that will help is fusion of the mid foot which scared me no end as it sounds so drastic and she seems quite confident that it will work out. However, i have also seen her colleague who agrees this is the only option left for me but that it is too risky as he thinks that one by one other joints in my foot will need fusion as they will compensate for the part of the foot that is fused. He has refused to do the surgery as i am only 26 and he thinks that it will be downhill for me as soon as i start having surgery. These two surgeons are supposed to be the top two in my area and with such conflicting opinions i really need to hear some advice from people who have had this done. I am due to have the surgery next month

I would really appreciate any help!

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Hey,

I'm currently lying in hospital after having my 3 cuniforms fused together. I was in a passenger in a car accident a year and a half ago which left me with a crushed foot. Before the accident I was a very active 20 year old, dancing and doing a physically demanding job. Along with a host of outdoor activities I loved. My lisfranc injury was diagnosed about a month after the accident. The first specialist I went to wanted to rush me off for surgery for no good reason. And the second decided that non-weight bearing for 3 months would be
better. I went with the non weight bearing.
Don't forget also that my foot was crushed,
so I have some fractures and a few partially
and totally torn ligaments. Along with
dents in muscles where bits of car cut in.
After 6 months of going along okay, arthritis starting showing up which pushed my recovery backwards. I tried acupuncture which did minimal, and pain killers which did nothing. After a year my doctor decided to try cortozone injections in the site of the arthritis to make sure that was where the pain was coming from. After finding out that that was the main site, along with my ankle that's still out. He decided a fusion would be the way to go. With my age he was very hesitant to do it unless I was certain. I did ad much research as I could and it seemed like a good option. However now I'm reading more forums on peoples problems, and wishing I hadn't had it done. I think it really needs to be a last resort. I may have forever destroyed my life that I wanted back so badly. So please make sure you have gone through everything before hand. Cause it's not reversible. I'll keep you posted on my recovery. Day 1. It hurts, it hurts, it hurts. And I'm not allowed any more morphine.
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Im sorry to hear about your accident, it sounds really awful. I too have had an active life quite limited and it has been 3 years now since my initial injury and i have tried everything to try to get back good use of my foot, including the things you have mentioned like the injections, painkillers etc. I also had a fracture, chipped bones and torn ligaments.
I was wondering what the reasons are that make you wish you hadnt had it done? Is it from your own experience or due to what you are reading from other people? I was quite encouraged from reading replies to my other post with everyone saying how glad they were to have it done and how much better their life is now. I am due to have my surgery on thursday 19th feb so am getting quite nervous now about whether i am doing the right thing
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Hey,
Did you end up going for surgery? I'm having my cast off and stiches out this Friday. My foot still hurts alot. Especially when it's not raised. I have a bit of movement in my toes, however I still can't feel the top of my big toe. No biggy. If I have it down for more than 5min my toes go blue. It has improved over the two weeks, but not as much as I expected. The reason I'm doubting if I should have had this surgery, is due to the conflicting things I've been told and read. My doctor estimated 4 months recovery. Bug people are saying a year! The place I'm working is allowing me back in a wheelchair, but our site closes in may. So I'll be out of work, and unemployable. And I have a mortgage. On top of that, people do find arthritis developing again in nearby joins if you are active. And I don't like the prospect of being a couch potato, or having surgery every few years. If I hadn't of had the fusion, maybe I could of gone on with the help of stronger painkillers, or something. But now I've sealed my fate.

I will keep you posted on my progress, and I hope all is well. Let me know the details of your surgery. lisamhilleard mac.com

Good luck
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Thanks for your reply. Yes i have had the surgery, i had it done on 19th feb. I totally understand the issue of keeping your foot raised, my toes go purple if my leg is down. As i understand it, it does take a minimum of four months recovery. My surgeon said that after that time we will see if the surgery has healed enough to start me walking again but she said that it can take a long time after that to build up strength and how far i can walk so that could be why some people say a year for recovery. I think it also depends on how quickly the bones heal.
I have discussed the possibility of future surgeries with my surgeon and she said that as long as i am sensible then that should be ok to minimise the risk. Don't forget that if you had not had the surgery, the way you may have walked to compensate for the pain could have impacted the surrounding joints with a similar effect.
I very much understand all of your worries as i am in a similar situation, i guess all we can do is hope for the best and keep in contact on these boards for any tips and advice

I would love to know how you get on when your stitches are removed so i hope you post an update
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Hi Everyone -

I had my talonavicular/navicular-cuneiform fused on Dec. 5, so I thought I would join in the convo. I had a horse fall down on me while I was on his back two and a half years ago and it completely crushed the navicular bone in my right foot. I had one surgery to repair the bone, but I developed severe arthritis in the two joints around the injury. I limped around in pain for as long as I could stand it and finally decided that I just couldn't handle the pain anymore. I got three opinions from all the top surgeons in my area and they all said a fusion was inevitable in my case. I had cortisone injections to isolate which joints were affected. After a week or so, the injections made me completely pain free for a few days, so I am praying once the fusion is healed, that is how my foot will feel. I was/am also concerned about needing future fusions, but I finally decided that I would rather be pain free while I am young (I'm 25) and take the risk of needing another surgery down the line. My surgeon thinks I should be fine for at least 15-20 years, if not forever, and that as long as I am careful and take care of it properly, it should be fine. It has been exactly 12 weeks from today and I am now in a walking boot and without crutches. The fusion was very successful according to x-rays and ct scan. I am relatively pain free in the boot as long as I don't walk too much. I started swimming this week, which is great. It doesn't hurt it at all and I think is actually helping to strengthen the muscles, ligaments etc in the foot. It is definitely painful to stand up on without the boot, but the pain I feel is more of a lack of arch support and muscle strength, as I don't have pain in the fusion. I have started doing basic arch strengthening exercises which seems to be helping a bit.

It is a really SLOW process for sure...one day at a time. I feel like I see progress every 2 weeks or so, and in between it kind of plateaus. I feel like I will probably be in the boot for at least another month.

I wish everyone the best of luck!
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You will recover and be happy again. The fusion works, some people have mishaps, however most do well.
Best of luck to you!
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Hi all.

Okay well it's been 3 weeks since my surgery. I saw my doctor at the two week mark so have my stitches taken out. And to have my cast off. That was an experience. He took the 10 stitches out on the main cut down the middle of my foot, then I started to feel not so great. By the time he had started on the 3rd cut where thebone came from, I was almost passing out. He had to complete taking them out with me on the floor. The two major ones were healed okay, but a small one on the inner if my foot wasn't. It is still very open. And very sensitive. The Arvo after my stitches were taken out I went to the Physio to have an airboot fitted. It's still very uncomfortable. I find it presses in all the wrong places. And the plastic that the air pockets are made out of crease right on my open wound. I have found that wearing thick cotton explorer socks helps. Just makes it that bit sifter. Also it means I can change the sock each day. Stops it from being itchy. Also ice packs put under the top part of the boot offer some relief. Most of the time it's a burning pain, or sometimes a stabbing pain. The pain killers don't do a whole heap. I'm taking calcium and glucosamine in the hope it will help the process. That's all I have to report so far.

How are you going Sarah? What do they have you in ATM? And how did you go with getting stitches out? I'm interested to know what your incesions are like, and how they are healing.

Mstesh- it's good to read your story. Your results so far are good. And very close to the time frame my doctor is expecting.

If either of you want to share photos, contact me lisamhilleard at mac.com

Good luck
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Hi
Lisa, i had the same experience this week when i had my stitches taken out! I passed out when they were taking them out and woke up with cold compresses over my face! One of the stitches on the main incision down the middle of my foot hadnt closed up very well so i had paper stitches put on to take care of that. Due to this i had to have a removable cast put on rather than a normal fibreglass type which they were going to use so i can see the surgeon again in a week or so to check on it. I thought my foot looked awful, around my heal was nearly black from bruising and of course the cuts look pretty scary for someone who has never seen anything like that in person before. The surgeon seemed to be happy that the incisions were healing well though.

I am surprised you had an airboot fitted straight away as i have been told that i have another 4 weeks in a cast before i can have an air boot.

I am sorry to hear that you seem to be having so much discomfort, i hope that it wont last much longer.

One problem that i have found after my surgery is that after about a week or so i started to have numbness and tingling in the fleshy part between my big toe and second toe. I mentioned this to my surgeon who touched the area and i couldnt feel it at all. She said that these nerves could have been damaged in surgery and that i may or may not get feeling back. It is a waiting game apparently but i got the impression that it wasnt going to affect my walking or anything like that.

Keep me posted on your progress, especially as we are at around the same stage in the whole recovery process

Take care and keep in touch!
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Hi Lisa and Sarah,

Looks like I am about 7weeks ahead of you guys. I had 1st met 2nd met. and my 1st two cuneiforms fused together. In all he called it a 4 corner fusion. My foot was also abduction latterally( from a wicked lisfranc that did not heal right) .
In the boot now an in a shoe next week. 3/09/08 will be 10 weeks for me and in a shoe- not to bad I thought.

The toe feeling and sensation will come back. I had the same things you are describing. No feeling at all, but it came back with time and walking on it ( blood flow helps alot when you start to walk ).

I cannot help out with the medial side incision since I do not have one. My Dr. had a unique approach and just did one long incision down the top of my foot. Prob stretched the hell out of the skin in the OR.

I start PT on Monday 3/09/08. Let you know how it goes. If you have any ? I'll check the boards as much as I can.
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Hey,

Sarah - Yeah its interesting that they don't just lie you down to start with. You would expect they would be used to it. Its interesting you say about the bruising. My foot has no bruising or swelling what so ever. It looks like my normal foot with a huge cut down the middle. The little one on the inside has a large waterproof band-aid on it. And the one on my shin is a big non-event. Its very fine compared to the one on my foot, even though it is atleast 5cm long. And he used dissolvable stitches on that one. I was a bit shocked by the size of the incision down the middle, but now that im changing my sock everyday, im used to it. I think i got an airboot so early because the healing was very good and i had no real tissue damage. The small incision on the inner was so they could get a screw in at the right angle without having to stretch the main one too far. I think that was a wise move. Also the cuts are very neat. Its kinda hard to describe, which i why i said if you wanna email me we can exchange picts. More detailed than a description.

I too have the same numbness between my big toe and second one. But once you get a boot you will probably also find that numbness extends over part of the top of your foot. My surgeon said they have to push a major nerve to the side to get in, and the stretching causes damage to it. However it will most probably repair. And if it doesn't completely, it will to a point (the area will become smaller). So yeah i wouldn't worry about it for now. Many more hurdles yet.

Also do you know exactly which bones they fused and how many screws? Also did they take a bone graft from your shin or hip?

Deano - Just a quick question to fill in some gaps. How old are you? Its great that you have joined our little discussion. Its more specific that some that go off the rails. If we can keep it to a specific surgery we can follow each other progress easily, which is great. Great that you are ahead of us by a bit, gives us a look into the future :p

10 weeks and into a shoe is very quick. Ive been very strongly told that 3 months of no weight bearing. Then he will talk to me about the next step. But he is very against Physio, as it can cause more problems if they get too excited about it. Most Physio's have never seen a midfoot fusion, so they tend to push the patients too far. I guess my advice to you is listen to your body. You are a better judge than the Physio will be, don't let them force it.

Good to hear that you have got your feeling back. Sounds exactly like what my doctor is saying to me.

Also, if you only had the one incision, they didn't take a bone graft? Like mine was taken from the top of my shin, but some are taken from the hip.

For everyone - Just curious if anyone has seen XRAYs of their foot yet? I had xrays done at the two week mark and its quite cool. Unlike most xrays you see where they look like self tapping stainless steel screws that kinda stick out, mine are just the shaft and they have no real point to them. Kinda just like a threaded rod. He said they are embedded screws. A bit different to the old style that was very common.

I wish everyone well, and hope to hear from everyone soon. I basically check the forum everyday. Its good to have people who understand to share the journey with. Also where are you guys from? Im in Sydney Australia.

Talk soon,
Lisa
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Hey Lisa and whoever else is out there.

To answer your? as best I can. Here we go:

35 Yers old ( very active male )
Ran the Boston Marithon on 4/23/07-- got my injury 1 year later and have not run since

Very athletic and in military shape- U.S airforce retired
Basically I am NO COUCH POTATO
Reside in Boston, MA USA

As far as the bone graff-- i did have one. I have a very small incision below the knee. It healed a few weeks post op. and I dont even think about it anymore.

I had The one incision because that was my Dr.s personal technique. I think they all do the job there own way with good results.

I have screw heads for the sole purpose of hardware removal if necissary. I have a plate on the medial side that pulled my foot straight again. If I want that removed due to iritation, then they can do it relatively easily with the heads of the screw. It is my understanding that the headless are perminant.

I had 4 bones fused. Basically the lisfranc joint ( first two Mets and the first two cuneiforms). I blew out the lisfranc joint from a 20' fall off the ladder.

From my research( which was quite extensive ) Foot bones fuse on an ave. of 9.5 weeks give or take a week. My Dr. said I was 85% fused at the 8 week mark and that Wt. baring was ok in the boot up to the 10 week mark. It is the wt. baring that will stimulate the bones to grow and gain density allowing you to fuse the rest on the way.

As far as Phisio goes- well The one I was told to go to as me in the pool and they are focusing on Gate along with leg strength. I am not a huge fan of PT, but gate is important. I think PT hurt me with round 1 of this injury. I had The ORIF on 4/01/08. Did the whole 12 weeks NWB and then the whole gamet of PWB c**p. From all the research and Dr.s I have seen it sounds like Fusion is the best think to due in the first place if you have a 3mm or greater diastis( gap bin your Lisfranc joint).

As far as future joint trouble- Well the jury is still out on this one -- even in the medical community. If you have your Navicular, talus, cuboid, or calcanius fused then you should be very carefull with the foot. These bones have joints that are very moble and need to move for the mechanics of the foot to work properly. This is why they do not use screws withn a ORIF on the 4th and 5th Met due to the high occurance of arthritis in the future. They will use K wires to line up those bones.

The mid foot is a very stable part of the foot. There is 4 degrees of motion in the first Met and 0 degrees of movement in the 2nd and 3rd. For this reason and more Midfoot fusion has been quite successful and most folks can contiue with there lives at a high level of activity. Now take that info with caution and don't start rock climbing or sky diving.

I hope this was helpfull. Basically I wrote down all the info The Dr.s told me and coupled it with my research to make my final decsion. I was in sooooooo much pain It realy was an easy decsion for me.

With this said - Always listen to your DR. even if others are mobile before you might be. Everyone is different and The Pros know best. I hope you heal well and are dancing again soon ( PAIN FREE ).
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orthosupersite.com/view.asp?rID=5767

Just an interesting article.
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Hey Deano,

Good to hear you were active before. It seems to be the trend with the others on this forum. The others seems to be older overweight people. It dosen't give us a good indication of their recovery. It doesn't take much to be a couch potato!! :p

I agree that everyone's surgery's are slightly different, i guess they have to be cause everyone's injury and foot are different. What ever works :-) I guess with the screw side of things, its a different story if a plate is put in, its more likely to cause irritation down the track. In my case the screws are embedded so no external hardware, which eliminates the irritations. My injury wasn't so bad that i needed anything further. So i think our doctors made wise decisions according to the injury.

That's interesting about the fusion time. I think my doctor is being overly careful with the 3 months no weight bearing. But i kinda figure whats an extra few weeks after 2 months. Im happy to do what he wants as he has been great so far (Ive been with him for a year and a half since the car accident). After the three months NWB i get to do what i want, at my own pace. I plan to use ballet exercises to strengthen the foot ankle and leg again. I have faith in that. Not some physio pulling and poking. But also my doctor has recommended starting swimming as soon as my wounds heal. As long as im gentle and not weight bearing :-)

The reason i didn't have surgery straight after the accident was i had a 2-3mm gap in the Lisfranc joints. Very boarder line for surgery. So we tried without surgery. And all was going well till arthritis showed up. So surgery it is.

I agree with what you have researched, we are probably spending hours trudging through the same sites :p I think with my level of activity, and how much strain dancing puts on the bones, i will probably get arthritis. But im happy to get my life back for a while. However long that may be. I couldn't continue on the way i was. Hopefully i won't, but i was happy to take that risk.

I hope your physio is going well. Please keep us all posted. Its great to hear all different sides of the injury. Shame we can't all meet for lunch, the gimpy club :-)
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Hi Everyone!

So i was wondering how everyone is doing with walking since a few of us seemed to be at around the same stage! I seem to have mixed feelings over my foot. I am getting some pain when i try to put full weight on it around the ball of the foot, the front and the midfoot region which sometimes i figure is all normal since it hasnt been 4 months since surgery yet. It would be great to hear other people's stories as i am starting to get worried that my surgery hasnt worked.
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