Physical Therapy and Lisfranc Fracture

Thank you for sharing that with me, and the forum. It helps to talk, and read.

Hi Chris, I injured my left foot on April 6th 2012. I had 2 screws and 2 pins placed in my foot. The 2 pins were removed but the screws are staying in per my doctor. Mt surgery was on April 19th, 2012. This week I get to put 25% weight bearing. It has been a long road. I am an active 46 year old female. I can not return to work until the doctor gives a No Restrictions note. How long until you had no restrictions? Did you do PT? Thanks for your input!!

Hi everyone! I've found it helpful reading all these posts. I fell and sustained my Lisfranc injury on June 6,2012 and had surgery on June 14, 2012. I was fortunate and was referred to a superb surgeon right away. While I am only 5 wks post-op things are going ok. I had fractures as well as dislocations so had 2 pins and one screw placed. Now have a soft light weight cast that can be removed for pin care - it's a godsend compared to regular casts. Ask for it when appropriate ( it's called a FRC - focused rigidity cast ). am able to flex and extend ankle twice daily out of cast. This helps with mobility long term. Also doing leg lifts for thigh muscles. No weight beating though for at least 12 weeks so that ligaments heal. My surgeon also prescribed high dose vitamin D and calcium for healing as well as multi vitamins and low dose aspirin for clot prevention. Other thing my surgeon did was to evaluate my gastronemius muscle and found it contracted. He released the muscle during surgery so my foot would realign and heal better. If you are having trouble getting recovery and mobility of the ankle joint, have you dr evaluate the calf muscle for contracture as this can contribute to poor outcomes after surgery and the muscle can be surgically corrected. I feel fortunate that my surgeon evaluated this preop and corrected it right away. Also, I had several acupuncture treatments early in my process using the toe points and points above the cast that really helped a lot with pain, swelling and bruising. I also think it has speeded up the healing process as i had never really had much swelling Well worth the money! Overall, keep faith. It is a slow process but if you take good care of yourself you can prevail! If you aren't recovering as well as you would like check out acupuncture, physical therapy, vitamins, massage, nutrition and mediitation or other mind body techniques. They all have a place in your recovery and can make a difference! Good luck to all.

I am happy to read your positive thoughts, I am now 7.5 months post op and my calf muscle is so tight that I cannot flex the injured foot at all. This is contributing to my limp. I still have foot pain and swelling and the limp is making my back very painful. I now have sciatica for the last 5 months due to the one sided balance. I am discouraged as I cannot get the foot to do what I need. I have done 5 months of PT as well. I am getting a second opinion on Friday. What should I discuss as far as the calf muscle again?

It's great to read others stories about their Lisfranc injury, treatment and recovery. what it shows me is that everyone is different and there is no standard treatment for this injury, every one is different. I too have a Lisfranc injury which I sustained on 15 April 2012 when I missed a step and fell down 3 stairs. I was overseas at the time and was about to get on a plane! I couldn't put any weight on my foot so had to get a wheelchair to assist me to and from the flight. After arriving back in my home town 6 hours later I went straight to hospital. I had an X-ray, normal non weight bearing which showed no fractures. I was told I had a sprain and to go home and put some ice on it. They gave me a pair of crutches to help me get around. Little did I know at the time how much use I would get out of them! A week later I am still in a lot of pain, foot is swollen up like a balloon and is completely purple and bruised. I had black bruising on the top of my foot and under the arch. I go back to my doctor and she sends me for another standard non weight bearing X-ray. Same result, no fractures, looks like a nasty sprain. I go home again. Another week later I see an ortho surgeon with my X-ray. He tells me I have a fifth metatarsal fracture. I queried this as most of the pain was in the arch and on the top of my foot around metatarsal 1,2 and 3. I had a 5th metatarsal fx about 8 years prior which I was fully recovered from. He insisted that is what it was and gave me a walking boot. Meanwhile foot is looking pretty revolting, it was still swollen, purple and black. So I start using the walking boot with crutches for about 3 weeks and then without crutches for another 3 weeks. Foot is still very painful (I had no pain killers!) and the swelling did not go down. The purple bruises started to fade but the black bruises stayed. I begged my doctor to send me for more tests. She sent me for an MRI, the report was 2 pages long. I didn't understand any of what it said. I go back to the ortho with the MRI and he says I have "a few other fractures" but the treatment is the same so stay in the boot for another 2 weeks then do hydrotherapy and physiotherapy for 4 weeks and it should be fine. I followed his direction. 4 weeks later foot is still painful, I now also have what I would describe as a crunching feeling whenever I put pressure on my mid foot. Walking barefoot is impossible, the black bruising is still present. I go back to my doctor again and beg for another opinion. She sends me to an ortho who specializes in feet. I had to wait several weeks for an appointment but I was finally able to see him earlier this week (it's now August). He looks at my MRI and sends me straight off for a weight bearing fracture. He wanted me to come back with the films right away. He tells me that I have a very severe Lisfranc fracture. I have fractured my medial cuneiform and cuboid and the third metatarsal has a spiral fracture. I have also fractured the base of my 1st and 2nd metatarsal, second cuneiform and have ruptured the Lisfranc ligament. The 1st and 2nd metatarsal are displaced. He tells me the type of injury I have is usually seen in people who have been in car accidents. He is amazed I have been managing with no pain killers. He said the bones are healing well and he wants to review me in 3 months for possible bone fusion surgery. He said that healing time for my injury is 12-18 months and I may suffer arthritis later in life. I was in complete shock. I still am. I'm a healthy, happy 40 year old woman, and this was a simple fall! My Lisfranc journey has only just begun!

so, i promised myself after suffering my lisfranc injury that I would write on the messages boards. I got so discouraged after reading these boards(though they were helpful). I just want people to know there is hope.
I'm pretty new into this still. I'm close to eight months post injury. I fell down the steps on Dec. 27th, 2011. I was carrying a lot of stuff in my hands and thought I was on the last step, but I wasn't. Ended up missing two steps and knew right away I had done something bad. I couldn't put any weight on it. I was out of state and went to an urgent care where they told me it was broken, but said I should see an ortho when I got home. I had broken my 2nd metatarsal. He put me on crutches and said no weight bearing. Took me about a week to get into an ortho ,due to New Years. Had xrays and the doctor walked in and said I'm getting ready to shock your world. He confirmed that I had broken my bone, but said that was the least of my concerns. He then told me I had a lisfranc injury and I would def. need surgery. He said it was pretty amazing that it showed up on the xray because they didn't do a weight bearing xray as i couldn't bear weight. After reading these messages boards and seeing how often this injury is missed, i was very thankful for my doc who was able to see it. I had surgery about two weeks later. Had to wait for the swelling to go down. I had a huge cast all the way up to my knee for 2 weeks till my stitches came out. After that it was in the walking boot, but I was nonweight bearing for a total of 6 weeks after surgery. After six weeks, i was able to start bearing weight in the walking boot. Took me about a week to get rid of the crutches. I didn't find it easy to start walking especially when you have used crutches for so long. After about a month and half in the walking boot, i was given the okay to start wearing shoes. I was able to get ortho inserts for my tennis shoes. I was told that I would be only wearing these shoes(with the inserts) for the next year. It took about a week of transition from big boot to shoe, but i was so glad to be walking. I had a really bad limp and my gait was terrible. My doctor made me wait until after my second surgery(to remove the screws) before having therapy. Looking back, I would have pushed for therapy in the beginning when I first started wearing shoes because I think i learned some bad habits which caused the limp to occur. I had the second surgery at the end of may to remove the screws. My doctor had always said from day one that I would have two surgeries. He felt like you didn't leave the screws in because they could break and also my injury was not as severe as some lis franc injuries can be. My understanding is that the more severe the injury, the more likely the screws are to be left in. He only had to put two screws and one pin in. The second surgery was ten times worse than the first. Supposedly your not suppose to be in pain, because screw removal is not a big deal..hahah. Not true in my case. With the first surgery I had a leg block, the doctor didn't see the need for that this time around. Moral of the story, i would have/should have pushed for the leg block. According to the nurse, I woke up thrashing in pain and moaning. She ended up giving me morphine(3 doses actually) which then affected my breathing. I had to go on oxygen and came super close to being admitted. Everything ended up being fine, but I would not want to go through that again. I was non weight bearing for a week after that surgery and then I was able to start walking again in the big boot. I started physical therapy at that point(which was the best decision I made). I went for a little over two months and it made such a huge difference! My limp is gone and I walk so much better. Sometimes when i walk I have to concentrate more because it is easier to start walking with a limp because I did it for so long. Im not yet running, but I think I could if I tried. I've never been a big runner. I go on walks and I try to increase my distance each time. I def. don't walk as fast I used to, but that is something I'm working on. All the pain is gone which is wonderful. I was blessed that I never had a ton of pain. It def. gets sore after walking on it, but that soreness usually goes away pretty easily.
Fortunately through all this, I only had to miss a week of work. I work in a nursing home and we do rehab, so we had lots of wheelchairs. So, for all the weeks i was non weight bearing, I would come to work on my crutches and then work in a wheelchair. I def. gained some muscles in arms, ha. My job was really understanding which was nice.
The only weird thing I had occur was about a month after my second surgery. I had a lump appear on my leg of the bad foot. My doctor called it a mass on my nerves. It has gotten smaller and smaller and doctor said it was like a hernia. It was odd that I never had it before and it was on the bad foot. It was on my lower leg right above my ankle. I'm gonna have an MRI, to make sure that it is nothing bad. I'm encouraged though that it has decreased in size.
My next goals are to increase my speed when walking and be able to wear shoes other than tennis shoes(though that won't happen till Dec). As hard as this road has been and it has has its moments(lots of them actually, ha) of discouragement, I'm def. glad to be on the other side of it. Don't give up hope,there is another side and you will be able to walk again.

My lisfrance injury happended in 07/2009. Orthopedic surgeon after seeing all bones across midfoot fractured put me in a boot for 6 weeks non wieght bearing then 2 weeks walking with boot. After 2 cortisone shots I am in excruciating pain and he is suggesting PT. Any advice is extremely welcome.

Had my home fall 9Aug2012. Surgery, five plus pins, three fusions and two plates. Kaiser Northern California, the care has been superb! So far doctor leaving all that stuff in my foot. Have progressed through scooters to walking cast and now back in a boot for a month. Reading all of your tales I am very lucky because the pain has been very minimal compared to what you all are reporting. Get boot off in a month and have started checking out what happens next and what to expect. Am a 65 year old Viet Nam vet working musician with type 2 diabetes. I hike the ridges and moutains of the coast near my home to control my diabetes and weight. Thank goodness the diabetes has behaved as I cut back inappropriate food intakes to make up for the complete loss of mobility. So, as I look forward I take from your experiences that we are all on our own. Each case is different. How I hope to be able to hike again!! Will let you all know how this medical drama unfolds as I enter physical therapy and try to get a prognosis of my future out of the doctor. Only advice I can give is to contact the nearest professional football team and get a head foot doctor reference from the training or medical staff.

Oct. 30, 2012. My daughter is 17 and very involved in competitive basketball.  She is in grade 12 and during fall basketball training, she cut hard while dribbling the ball and came up limping, barely able to place weight on her foot.  There was no impact with another player. She just placed a lot of torque on her foot and suddenly it hurt.  Oct 31, 2012. We took her to emergency the next day where she had x-rays. The doctor determined the injury was Lisfranc and referred us to an orthopedic surgeon. Nov 2, 2012. We saw the surgeon and had several more x-rays.  He could see there was a 2mm separation between the first and second metatarsal. No broken bones.  Because it was just an x-ray, could not see the ligament but due to the separation and the Doc's experience, he new the ligament was snapped.  Offered two options.   Wear a walking cast for three to four months and ensure a poor outcome and arthritis within 5 to 7 years or surgery and a chance at playing university basketball and less likelihood of less severe long term problems.  Daughter was devastated and scared but chose the surgery because she wanted to go on to play basketball in university. As far as I've read, other than the injury being just a sprain, this might be the simplest form of Lisfranc Injury. Nov 5, 2012.  Had surgery.  Normal incision and a single screw to hold bones in alignment.  Placed in a half cast and wrapped tightly with elastic bandage.  Pretty severe pain for first week.  Nov 14, 2012. Had stitches removed and allowed to wear a walking cast but must be non-weight bearing until the doctor says.  More pain but only for an additional week.  At just 2 weeks, she has lost considerable muscle mass.  No scooters, just crutches.  Starting to get good at them now.  Will see doctor on Dec 19, 2012 and find out what her next step will be.  Tough on her now because the high school basketball season has just begun and she is sidelined.  Many college coaches have never seen her play before so now we have to rely on film and club and high school coach's recommendations.  Can relate to father of football quarterback.  I will ad more as she progresses.  We do not think she can recover before the end of the season but who know for sure.  Hope her experience can help other young athletes.   

Your post was exactly what I was looking for my 16 year old son injured his foot in a soccer game he was slide tackled in Oct, it was misdiagnosed for a month as "no break and possible turf toe" he had a shooting pain every when he pushed off or twisted at all. They found he has a 1mm Lisfranc sprain between the 1 and 2nd met. and had a stress fracture of his 2nd met at the base, for sure it is unstable. We are looking at having surgery possibly this Fri Feb 1st. Your advice for pre surgery is what I was looking for. Thanks a million
Sally (mom)

Please keep posting her recovery, curious did you all have the nerve block the QB dad was talking about during surgery? My 16 year old sons soccer injury Oct 14th 2012 was misdiagnosed completely for 3 months they did find a a stress fracture base of 2nd metatarsal at the beginning of Dec put him in a walking boot 4 weeks, 10 days later he had terrible pain from instability finally found the right Ortho diagnosed Lisfranc's Sprain 1 mm sep between 1st and 2nd met , having surgery hopefully Feb 1st doing a stress x ray test for stability and possible screw insertion, with removal 3 months later nwm...
Q: how did you handle the swelling and keeping foot elevated in bed?
curious why you opted for no scooter? (thinking of buying one 2nd hand)
How many school days did she miss, (we were told a week)
Any more suggestions pre or post surgery are welcome, good luck to her!
smiles,
Sally

I'm 5 months post-op (orig) op and just had my screws removed. Sorry to hear about the lack of progress. It seems you're doing PT and not having positive outcome--I highly recommend working in the pool for mobility and on a spin bike to build strength and flexibility...the increased blood flow to the foot brings amazing results and speeds healing...

Thank you so much for your advice. I ended up needing fusion done. There was a secondary injury behind my original ORIF site that needed fixed. I did that Dec 4th 2012 and am now starting PT all over again after all these weeks of non weight-bearing again. I feel like I am doing last year all over again. I was just told today that I can start walking and get into a shoe for short periods of time. I still need to wear my walker boot for everyday things until I can do a shoe comfortably. I am hoping the fusion will have taken care of the sharp pain in the mid foot during pushing off when walking. So far I have no idea how that will go. I am tired. :(

Fusion sounds like the way to go and you'll prob be doing very well soon. Like I said, the spin bike is amazing and should be part of every rehab regimen for this injury. You can work your conditioning and build up strength at your pace, slowly adding resistance and standing up for increasing intervals, all while improving flexibility and blood flow/healing. Another thing I'd recommend is to buy a foot massage roller (lots of cheap wood ones on the internet, I found a great rubber massage roller at Target) to work the scar tissue, mobility and circulation. Add a good multi-vitamin and extra b-vitamins for nerve damage repair, and extra Calcium and Vit D...nutrition is often overlooked and extremely important. Hope your progress speeds up every day!

Hi guys.

I know this is a belated response considering all the posts on this thread were from quite a considerable time ago. 

I am 20 years old (male). Formally represented my country in Rugby Union at junior level. I Suffered a double fracture in the mid foot. Resulting in surgery, non weight bearing boot for 4 months and have since recovered quite well. 

I am now about 5-6 months post having my screws removed and can run comfortably, sprint to a certain extent and do most activities i.e touch football etc pain free. 

However i struggle with A skips (for those who know what they are), stepping down form considerable height, hopping and am still a long way from where i use to be in terms of speed, balance and power. 

I have been toiling away for months at this. 

Can anyone shed some light on whether they returned to full fitness (speed, power etc) it seems that physio's doctors etc are happy for me to return for checkups with same phrase "keep doing your calve raises". 

Cheers.