I just wanted to add my 2 cents. I had a severe Lisfranc injury with fracture of the 2nd, 3rd, and 4th metatarsals right at the midfoot as well as a fracture of the 5th cuboid on 1/26/11, after sliding in sock feet on our sloped driveway. Foot slid inside sock and folded underneath - toes toward my heel - and I saw the whole thing - sat there on driveway and watched the foot unfold and I said - Oh c**p - you really did it this time! My first broken bones!
About 2 weeks later after swelling went down, I had 1 screw thru #1 & #2 metatarsals to supposedly fix the LIsfranc & then 3 pins to try and stabilize the fractures. The pins backed out on their own and had to be removed 3 months after surgery, and the screw was causing so much pain that it had to be removed 5-6 months after initial surgery. That doc basically botched the surgery! If you want his name...just ask. He does not know how to fix those fractures sufficiently. He is in San Antonio, TX. My comminuted displaced fractures were much too severe and Lisfranc much too severe for such a small surgery.
After screw was removed...over a couple weeks' time my foot started to shift and I had a huge lump on the inside of my foot. Went to a new doctor. He ordered a CT scan and told me that no fractures had healed (after all I had been through nonweightbearing and falling with crutches, etc!!!) and the Lisfranc was a mess, and my whole midfoot was filled with arthritis. Everything was shifting and unstable.
I was referred to a doctor deemed to be the TOP FOOT AND ANKLE SURGEON IN THE WORLD - YES....THE WORLD. His name is Mark Myerson, MD, and he works out of Mercy Hospital in Baltimore. He takes most insurance (if he took mine - he will probably for sure take yours). It is worth the plane ticket. Flew in one morning, preop visit that afternoon, surgery the next morning, back on the plane the next morning. Shuttled around by the hotel people, and I did it all alone. They do make you hire a nurse or an aid or someone to leave the hospital with. They give you a list of agencies to call, and they were all about $20 an hour. I only hired them for 2 hours just to get me out of the hospital and to my room and situated.
On September 13, 2011, so 6 months ago, Dr. Myerson did a midfoot arthrodesis (fusion) with a plate that has 4 screws, plus I have 3 more big screws going through the 1st and 2nd to keep that area held together. The plate screws go through the base of the 2nd and 3rd and through my midfoot itself. I also had about a teaspoon of bone grafted off the top of my heel and put into all of my fractures to help promote healing and fusion. I have about a 4-5 inch vertical scar just left of center on the top of my foot, about a 2 inch scar beside my Achilles tendon where they entered my heel for the graft, and then a couple of screw "cross" cuts on the inside of my foot. That isn't to mention the scars from the first surgery!
For anyone considering arthrodesis (fusion) for a problem such as this, which is what I gather some of you are facing too, I personally think this is the best decision I have made so far. I don't know what my outcome would have been if I had not found Dr. Myerson, but I know my foot was "falling apart." From my midfoot forward, the foot was shifting outward. It was wierd. My friend said as she looked at my feet straight on from sitting in front of me, she said it was like half of my foot was turning out. I couldn't see it as well myself.
Another problem - I was told to take TONS of Advil, Aleve, etc., after I had my first surgery. I must have taken bottles of it for the antiinflammatory effect as well as for pain control. According to Dr. Myerson...YOU SHOULD NOT TAKE THESE NONSTEROIDAL ANTIINFLAMMATORY MEDICATIONS WITH FRACTURES (BREAKS) (i.e., aspirin, ibuprofen, naproxen) (basically, Advil, Motrin, Aleve, etc., etc.). Tylenol is okay. He is extremely generous with the narcotic pain meds because he knows you can't take the over-the-counter stuff, so you don't need to worry about pain. I guess this is a relatively new discovery - that they are finding that ibuprofen and naproxen and other "nonsteroidal antiinflammatory drugs" are PREVENTING BONES FROM HEALING. So if you are on ANY of those - GET OFF OF THEM NOW! If you don't believe me, call Dr. Myerson's office. If you have broken bones now, don't take them!
My internist didn't even know about this new discovery about those over-the-counter meds, so it is probably something that ortho surgeons are finding out first because they are the ones who deal with the bones the most.
Okay - Anyway - Dr. Myerson was also able to remove all of my arthritis in my foot as well. He felt that I would be able to "walk 5 miles again" one day (as if I ever did that before - lol!). The technique that he uses is successful long-term in 93% of patients. I didn't ask him what happens in the other 7%. He did inform me that my previous surgery "just wasn't done properly" and that is one of the reasons my foot didn't heal right. Things just weren't aligned and "fixated" well enough which allowed too much movement. My guess is I was allowed to weightbear much too early as well. Between the ibuprofen and the bad surgery - I was a mess. I had to start over from square one.
With Myerson, I was nonweightbearing for 8 weeks, and then I was in a walking boot for another, I think it was like 43 days. I was then able to come out and go into a good shoe, which I use a good tennis shoe (not a bouncy one...but a firm inner sole...with an arch support inserted that I bought).
Okay - Long story not so short - 6 months after the surgery I am walking around just fine IN SHOES. I will have pain if I am on it TOO long. But just normal everyday stuff - not a huge problem. I have a little pain in my arch here and there off and on - like right at this moment, there is one spot that has a little bit of throbbing pain, but I would say it is like a 2-3 on the pain scale - just annoying. It really varies from day to day and with what I've been doing. I tried to go back to doing hair, but I couldn't handle THAT. Standing for that long on my foot was killer. By the end of my 6-hour days, I was a hurtin' girl. Now I have to do a sit-down job.
I do have a lot of trouble with walking barefoot. It feels like there is a golf ball on the ball of my foot right beneath the big toe. I don't know why. If I rock my foot back and forth on that area, I can feel what feels like tendons shifting across that bone. It is wierd though because the area is no bigger than on the other foot, isn't swollen or anything. It is just ultra sensitive and feels like the bone is bigger. That's the only way I can describe it and I wasn't even injured there. A great deal of the top of my foot is numb, but that came in handy when they took my stitches out - I didn't feel a thing, and they were REALLY embedded in there. You don't notice it unless you touch it though. I have 2 spots that are pretty sensitive if I touch them, but if I leave them alone, they are pretty okay. For a while I wore a gauze pad taped to the top of my foot so my shoe wouldn't irritate that area, but the last couple weeks I've done away with the gauze pads. When I raise my toes up, my 3rd toe lags behind. I have feeling in the 3rd toe when I touch it but I can't make it move. Not a problem - who cares. Doesn't affect anything. Was told this movement "may" come back.
My foot still swells some - very little compared to what it did for several months though (and yes - for months after surgery your foot will turn purple when your foot is down - both surgeries brought that on - doesn't turn purple anymore), and I tend to keep it up at all times (while I am writing this, I have my foot up on a chair). I just tend to think it doesn't swell as much if it is up and it hurts less. It also gets "tense" or "tight". I can't explain it but the whole foot will feel tight sometimes and it will be uncomfortable to try and walk with it tense like that.
Heat definitely helps. If I warm up my foot it is like everything kind of relaxes and feels better. But it is a pain in the butt to always put something on it to warm it up, and of course, it doesn't last.
I had several x-rays for about 3 months because I kept thinking something was "wrong" because of pain and I also fell once, but the last picture taken in December 2011 said everything was healed perfectly. The 4th metatarsal complete fracture was healed so well that they didn't even mention it in the report.
I was told that my hardware will probably not come out unless I have complications. I still limp just a bit, but I think that is more because I lost my insurance (couldn't afford my COBRA payments any longer) and I wasn't able to go to physical therapy, so now I'm so scared of doing anything to hurt it that I am overly careful. However, if I am on a job interview or at a function, I CAN walk without limping. Learned the fist time around in physical therapy that you MUST walk by rolling up over the first metatarsal and onto the big toe or you are not walking properly. Unfortunately, most of us who have this injury end up walking on the outside of the foot. I just read today that that is why they don't put screws in the 4th and 5th when there are fractures. I don't know if that is true or not.
Anyway - I hope this helps. I'm living a pretty normal life. I take hydrocodone with Tylenol once or twice a week just because it makes all the difference in the world if I am going to be on my foot for a longer period of time. If I don't have anything going on that is going to aggravate it, I don't take any medicine.
It rarely hurts if I am completely off of it. In fact, sometimes when I wake up in the morning, I forget that I am not "normal" anymore, and as soon as I step onto the floor, I remember that my life will never be the same :(
However, I do recommend the fusion. I don't think I'd be living the relatively normal life that I am (minus running, hiking, jumping, etc.) if I had not have had it. And overall, I would say the pain is just minimal compared to what I am reading with some people's results.
I think we are stuck with our pain and injuries for the rest of our lives when we have this type. PLEASE CALL DR. MYERSON. It is worth the plane ticket and the 2 nights in the hotel that gives you an amazing discount (across the street). He will also evaluate your MRI/CT/x-rays or whatever and give you a personal phone call and tell you if and what he can do for you. He didn't charge me for doing that. His office staff is the most efficient I have ever worked with. Don't know if you need a referral. You can ask them.
He is hard to get into and I hear it can take months. I kept pressing and kept pressing and kept pressing about needing to get back to my life (I don't have anyone supporting me but myself!) and they ended up getting me in for surgery less than a month after I was told about him. He was amazing. Here is his website:
I hope everyone does well. If you have any info regarding why I feel like I'm walking on a golf ball when I am barefoot but not in shoes... please reply! I sure hope this fusion works. It is 6 months, but every week I think I can see SOME type of improvement - like getting rid of the gauze pads in my shoe. I was told maximum medical improvement can be expected between 6 and 12 months, so I am hoping that a whole lot more improvement happens in the next 6 months.
Someone else has a golf ball on the bottom of their foot! :) I'm sorry! I wouldn't wish it on my worst enemy. I had all of those same pains before, and I had them with the fusion too, but like I said, they are getting better or gone, depending on which one you are talking about. "Jammed up" is a good description of the "tense" or "tight" feeling that I still get off and on. TOTALLY a good description. I think we both did a whole lot of nerve damage that causes wierd sensations.
Right now, 6 months down the road, even though I did away with the gauze pads, I would say my two most bothersome issues are the pain in my arch when I walk and sometimes when I'm not walking, and the sensitive skin on the upper inner part of my foot - like it is so sensitive that it hurts to barely touch it, but if I DO massage it for a couple of minutes, it calms down. That's why I think it is nerve pain.
One time a little more than 4 months after ORIF, I was in an airport when "spasms" started in my lower leg even. It was my left foot that was injured too, so if you take your right hand and touch your left ankle on the inside, then move your hand up your leg about 3-4 inches, then move your hand left about 1/2 inch toward the bone, that is where it was spasming, and I mean, it took me to the floor every time. So embarrassing. It happened about every 10 minutes for about an hour at a time for just a couple of days off and on. Hurt so bad I thought I was gonna die, and it was a nerve pain - a "shove a hot poker and butcher knife together into my leg feeling," and there was no warning - just came on instantly!
After I had fusion I would lay in bed at night and my foot would "jerk" so violently to one side or another that I actually twisted my knee once, and once I even thought that I had ruined my fusion. It would wake me up out of a dead sleep. I was still in a cast or boot too. They finally prescribed a muscle relaxer for sleeping so things would calm down. It did after a couple of weeks.
I like that name...Lisfranc-ers! Funny! We SHOULD have an official title after all we've been thru! :) GOOD LUCK AGAIN!
interesting to hear experiences from Fusion Lisfranc-ers...
club members (see signature below) have been asking for info from such as yourselves
Interesting about the NSAID - I was diagnosed and dosed with them in hospital, and prescribed them on discharge
took them religiously for first 9 weeks or so, mentioned them to my consultant who instantly told me to STOP taking them - for the reasons you list
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