Lisfranc dislocation question...

[pointedem]

Long story short:

Instacare missed it on the xrays 24 hours post, primary doc missed it again on another set of xrays 2 weeks post. Different doc recognizes it on 3rd set of xrays 6 weeks post and today I see a surgon 7 weeks post.

I sure didn't expect to hear the words "life changing injury" today. The option he presented me with was fusion of the distal 3rd to 1st metatarsals to the corresponding tarsal bones (big toe>to 3rd toe). I can walk and stand ok, but trying to balance on the ball of the affected toe is very limited- 2 seconds tops @ ~80% of full extension.

Has anyone else dealt with this injury, if so did anyone use fusion as treatment? The doc told me it would be about one year until I'm close to fixed (3m non weight bearing, 3m cast, 3-4m PT). Just trying to gather as much info as possible right now... any input from others is much appreciated.

info on lisfranc dislocation:
[ame]http://en.wikipedia.org/wiki/Lisfranc_fracture[/ame]

thanks...

[haydukelives]

do a search on google scholar.....you will find lots of orthopedic journal articles

[yooper]

I had one that went completely untreated about 15 years ago. After about a year, it was ok.... I have always been aware of it, but livable. Very active lifestyle.

I've had pretty chronic, but tolerable pain for at least the last 5 years... I'm getting arthritis pretty bad because there is no joint space left between the Cuboid and Navicular. They say I'll have to get that joint fused at some point.

If your lisfranc joint isn't right, it screws up the whole support system of your foot. Good orthotics have helped me quite a bit.

I'd get a second and third opinion from a Podiatrist that is an athlete.

The good news is, this injury will never affect your skiing. The boot provides all the support you need.

[pointedem]

Interesting thanks for the reply yooper. Thing is I could barley get my foot into a room temp ski boot- very painful. Working on 2 and 3 opinions as we speak.

Can you sprint/ stop/ change directions w/o pain?

hayd thanks I'll check that out.

[Vinman]

hmmm. tough injury. You "might" be able to do those things again. It is very tough to predict. Maybe with a good surgeon, time, rehab and good orthodics you could be able to do some of those types of activities again. Again very tough to predict.

[wildstyle]

i strained my lisfranc ligaments in my left foot 3 weeks before the start of the ski season last year...( my injury was nowhere near as bad as yours)... I had a lot of pain but knew it was not a full dislocate or anything near ... just a bad strain ..

I am married to a physiotherapist so that helped.

I tried out the ski boots and found that the boot acted as an excellent support cast.

3 weeks after the injury, i was skiing totally fine. As soon as the boot was off, i was hobbling around and in pain... back in the boot and i could walk and ski normally.

It took me 3 months to sort out the injury. I could not do any full weight bearing sports until it was healed.
no squash,racketball,tennis,football, ...anything like that. Just skiing.

[yooper]

Can you sprint/ stop/ change directions w/o pain?

I can do all those things without severe pain.... The foot basically always hurts now. More an annoyance than real pain most of the time though.

I play basketball almost every day, and can do everything I always have been able to. I do wear a swedo lace-up ankle brace and high tops to support my foot as much as possible.

[lynchdogger]

Certain my injury was different than yours. 17 weeks ago my foot was crushed at work and fractured 2 thru 5 metatarsals and 2 thru 5 cuniforms with linsfranc fracture - yes, thats 8 fuck'n bones. Lucky to still have foot so I guess I'll deal. After 2nd opinion I went with two pins to stabalize joints at base of 2nd and 4th metatarsals. Originally ortho surgeon recommended much more aggresive procedure similar to your recommendation. However, 2nd opinion suggested pins mostly because extent of fracture not because of dislocation of joint - had minimum. 2nd surgeon said if fractures weren't bad he would recommend no surgery. Guess it depends upon extent of dislocation. Would definetly seek 2nd opinion and be sure it is with the best foot and ankle specialist your healtcare will get you access to! Don't take any ortho's recommendation - most have specialties. Foot and ankle guys have an xtra year long fellowship after residency to gain specialty. Same scenario as yours from sound of things. Here's how mine went - was in cast for 12 weeks - had to wait two weeks for trauma and swelling to calm down and aircast for three weeks after. Baby steps since but have graduated to long walks with family and dog to light biking. Then last week re-built my chimney and re-roofed my house with the help of two employees (they did all the heavy lifting)! But thank god for pain meds! It's a long painful road my friend but on my way to full recovery. Hope that helped? Good luck!

[pointedem]

thanks for the post---

[Orthoski]

Sorry to hear about your injury...the good news is that if it was not visible on initial films, presumptively there was no displacement of the bones (sometimes you can only see the bones displace due to a torn Lisfranc ligament on weight-bearing views). Fusion is one of the treatment options because there's very little motion at baseline between the 1st-3rd metatarsals and their respective cuneiform bones. There are often multiple appropriate ways to treat a given injury, and the most important thing is that you feel comfortable with your treating surgeon. That alone may be a reason to get a second opinion. You've got a road ahead of you, and you should always feel like you would have made the same decision all over again.

[pointedem]

Going to see a doctor that does AK (applied kinesiology) next week. My friends father is very highly regarded in this field and he referred me to one of the best in the west supposedly. Keep you guys posted....

[Ed el Loco]

I blew out my lisfranc mountain biking in October:
[ame="http://www.tetongravity.com/forums/showthread.php?t=172267"]Any one ever have a closed dislocation of the tarsometatarsal? - Teton Gravity Research Forums[/ame]

Just used my right foot today for the first time in 2 month. Here is some med chat sight info I found, most of the stories are pretty grim.
http://www.steadyhealth.com/Lisfranc...II_t82763.html

I didn't find mine that painful, but trying to walk after no wight for 2 months hurts pretty good. Good luck.

[pointedem]

ed- what was your injury... A dislocation or fracture? What was your treatment? Is that a fusion or ORIF? thanks in advance.

[Ed el Loco]

Dislocation only, I think the ligament was severd, but its only soft tissue, no fracture. So the plan is to let the scar tissue reconnect the ligament, if that fails I will need a fusion some day.
I had a hard cast for 2 weeks followed by a cam boot for 6 more. No weight for 8 weeks total. I just began standing on it yesterday and I should be 20% weight bearing first week, 50% next week, 80%, 100% at week 4, but I am pushing 50% now. The plan is to have he screws removed fist week of Feb. When I recover from that I will be able to resume "normal" activity. Apparently riding a bicycle to work every day and skiing 2 times a week is not normal activity?? The Dr. is saying 6 months to a year before I'm back to my normal activity level. Hope that helps. If you do have the surgery I'll give you my swimming cast cover, getting in the pool really helps.

[pointedem]

so I had surgery. Pretty burly surgery to say the least. Took bone from my shin to fuse my foot together. 54 days and counting until I i can put weight on it.

[Ed el Loco]

Its a brutal long road, I started weight baring on the 17th after being off for 8 weeks, last tuesday I was finally able to get around with out a crutch or cane. It took me about 3 weeks before using crutches was any thing less then painfull. Go the pool if you can, it's the only thing that maid me feel like I could move freely.

[pointedem]

1.5 weeks post surgery-- feels so much better. Been taking biost
http://www.standardprocess.com/displ...alog.spi?ID=21

who knows how much it's helping, but I figure it can't hurt. I'll post updated xrays on monday after my appt.

[splat]

Wow. Best of luck with the healing, pointedem.