Is discoloration normal with Lisfranc injury???

I am at my wits end with this injury, so will you please give me some direction about it? I sustained a foot injury on Jan 1, 2009. XRays at the ER were diagnosed as Lisfranc fracture. The 2nd and 3rd metatarsals received nondisplaced fractures. I've been told there are several fractures from the injury. ER took precautions against lisfranc fracture and sent me to Ortho Spec immediately. The following day, Ortho Dr agreed but stated weight-bearing xrays should the same amount of spacing between both feet. However, pain was so severe that I could not bear ANY weight on my injured foot at all. I have gone through 3 weeks of walking boot and 3 weeks of a cast. I went to surgeon to decide whether to have surgery - my appointment is Friday. My concern is the overwhelming PAIN that I still experience, the extreme swelling that is still going on and the discoloration of my foot. If you looked at my feet only you would think they belong to 2 separate people - Not because of the swelling BUT THE COLOR! My foot has gotten so dark (I'm a light-skinned African American) that I have become afraid of what's really going on. Can you offer any indications as to what could be causing this? What should I do about the swelling and the pain?? I am considering going to the doctor tomorrow and just wait to be seen for this pain....

Are you seeing a Neurologist? Perhaps maybe a Podiatrist? You may want to write down all your symptoms to take along with you on you next office appointment. You also may mention a condition called RSD or known today as CRPS. This is more of a neurological disorder. Unfortunately there is no cure for CRPS. They can only prescribe pain med's to keep you comfortable, and a decent dose of Physical Therapy for it. I wish you all the best with your condition. But it's best to know what you are up against, verses not knowing anything at all, and just guessing. Good Luck my friend.

What is CRPS? printer-friendly version

Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy, is a chronic neurological syndrome characterized by:

severe burning pain
pathological changes in bone and skin
excessive sweating
tissue swelling
extreme sensitivity to touch
[For a complete description of CRPS symptoms, please read the Diagnosis section of the Clinical Practice Guidelines section of this website.]

There are Two Types of CRPS - Type I and Type II

CRPS Type I (also referred to as RSD) - cases in which the nerve injury cannot be immediately identified
CRPS Type II (also referred to as Causalgia) - cases in which a distinct "major" nerve injury has occurred
CRPS is best described in terms of an injury to a nerve or soft tissue (e.g. broken bone) that does not follow the normal healing path
CRPS development does not appear to depend on the magnitude of the injury. The sympathetic nervous system seems to assume an abnormal function after an injury.
Since there is no single laboratory test to diagnose CRPS, the physician must assess and document both subjective complaints (medical history) and, if present, objective findings (physical examination).
Criteria for Diagnosing

Complex Regional Pain Syndrome Type I (RSD)

The presence of an initiating noxious event, or a cause of immobilization
Continuing pain, allodynia, or hyperalgesia with which the pain is disproportionate to any inciting event
Evidence at some time of edema, changes in skin blood flow (skin color changes, skin temperature changes more than 1.1°C difference from the homologous body part), or abnormal sudomotor activity in the region of the pain
This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction

Complex Regional Pain Syndrome Type II (Causalgia)


The presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve
Evidence at some time of edema, changes in skin blood flow (skin color changes, skin temperature changes more than 1.1°C difference from the homologous body part), or abnormal sudomotor activity in the region of pain
This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction.

Not sure if you've been back to a doc yet, but I too had a lisfranc injury. I also broke the second and third metatarsals. Were you on crutches? I was told to be completely non-weight bearing for six weeks after the injury. During that six weeks, I was in a hard cast for 3 weeks (should have been the whole six weeks but thats another story of my stubborness lol).Then another six weeks in a walking boot. In the first couple weeks after the injury, weight bearing wasn't even an option, way too painful. Even now, I still get sore after walking a lot. (Injury was in November 2008, didn't get out of the walking boot until Feb 3, 2009). It's a nasty injury that from what I've read takes a long time to heal.

I too had a lisfrance injury occur in November 2008. No surgery, but was non-weight bearing with crutches for 6 weeks in removable cast and then another 4 or 5 weeks in the walking cast. Since end of January have been wearing custom orthotic supports in my shoes. I too still notice discoloration of my injured foot. What seems odd to me is that it primarily noticeable when I take a shower and for a short time immediately following. I'm comforted to hear that the last poster who's injury occurred around the same time mine did, still has discomfort. My foot also swells every day. 99% of the time, I will wear shoes with the inserts when I walk. Although I will take short, cautious trips around the house without.

I am thinking about going back to doc for a follow-up at this point just to ask if what I am still experiencing is normal. Even though the doc said there would be no need to come back if I was doing ok.

I hope the original poster comes back and gives an update.

Glad to see someplace where there are recent posts....I had a lisfranc injury 12/08. Had surgery 1/14/09 where 3 screws were put in place. Have been in a cast since then and just had it removed 4/14/09! That part was hell! The entire time in the cast was non weight bearing. MD still wants me to be non weight bearing until next surgery, 5/16/09, to have screws removed. My foot has been in soooooo much pain since the cast removal!! The foot is also more pink/purple in color than the normal one. Trying to work on moving my foot now for it is VERY stiff from being in a cast for so long. Would be willing to share more of my story in detail with anyone....or answer questions....Hope all going through this type of injury is healing well : )

This is an update to my original post PRIOR to surgery. I have been completely non-weight bearing since Jan 1, 09. I've gone through several cast changes but still in a cast. Doctor decided to perform surgery in March where 2 screws were inserted. This was a very painful surgery!! I was in excruciating pain for the first 3 days post-surgery. My foot was placed in a different type of cast during the 2 weeks after surgery - a plaster cast made immediately after surgery. During this time I had my foot elevated to the ceiling to help alleviate the pain and the swelling AND the COLOR seemed to return to normal. The color on the injured foot was vastly different from what it had been that I was happy - even though I was still in a considerable amount of pain. After 2 weeks in that cast I returned to the regular cast and lo and behold - DISCOLORATION!! It's been 6 weeks since the surgery and my family and friends describe it as a "Neanderthal" like foot.

I guess as long as the cast compresses on my foot it will change colors and swell. My new concern is whether or not I will have to have another surgery to remove these screws. How do they decide whether to remove them or not? Is it painful? Does it require anesthesia?? I certainly hope it does because putting them in was excruciating! Let me hear from others who can identify with the "WORST INJURY THAT YOU CAN SUSTAIN TO YOUR FOOT".

Hi
I too sustained this fracture Jan 11 of 2009. I was non wt bearing until screw removal which was done at end of May. Long 20 weeks!!! Screw removal was Ok and done under local with a bit of sedation. Walking is a constant struggle!!!!! I swell to the size of a football with softballs on the side of my ankles. Colour still off, I know what you mean to having 2 feet from 2 diff legs!!!LOL Pretty crazy eh?
Walking with crutches is an adventure on its own. I wish you lots of luck. I despair ever walking normal some days, or ever wearing a pair of shoes again!! I can sustain only for short distance and short periods. If I push I can barely make it at night to walk to bed, so take it slow and well have to see how long it takes. My work is expecting me back in 3 weeks but I dont think i can manage unless things change alot. I am a nurse, running 2 units and I do ALOT of walking and running.
Good luck and please repost and let us know how you are doing. It is helpful to know we are not alone with this crazy fracture.

My 20 year old brother just had this injury one week ago. He broke 2 metatarsal bones, 2 tarsal bones, his ankle bone and the lisfranc ligament. He will be having surgery Monday (9 days post-injury) where they will place three screws. What can we expect as far as the healing process? So far, he has been in a lot of pain (even though he is taking pain killers every four hours). The pain seems to be sporadic, he feels like his foot is "cramping." Did anyone else experience anything like this?

Thank you!

I sustained a lisfranc injury in June 2010 at the age of 31. I have been non-weight bearing since then and it has been very tough because I am very active. I fractured my second metatarsal and had surgery 2 weeks after my injury to insert the pin. I have had a positive experience with this type of injury in regards to pain, surgery, and crutches. The scarring from the surgery almost doesn't exist. I am currently in a boot that I can take off and I am still using crutches. I am also very concerned about the discoloration in my foot. At first I thought it was just dead skin, but as much skin as I have scrubbed off, it is still darker than my other foot. Maybe when all the bruising is gone my foot will return to normal color. My other concern is about leaving the pin in. I have read articles about pin removal and what can happen to pins that stay in indefinitely. Since most of the posts are fairly recent, is there anyone who has had a pin in for several years? I have heard that after pin removal you have another few weeks of non-weight bearing because it is possible to re-fracture the area. I currently still experience a great deal of swelling and can't imagine what that will be like when I am able to start wearing regular shoes again (heels). My job consists of a lot of walking and I have pretty much kept up with that except I use crutches and sometimes a wheelchair when I have to carry materials. I go back to visit my doctor in a couple of days and I am optomistic that he will tell me that I can start putting minimal weight on my foot. I am really just looking forward to being able to stand on 2 feet!

[FootDoc]

Long-term and sometimes permanent discoloration of an injured and even just an operated foot is not uncommon, but you should let your own doctor opine as to whether is portends a problem.

When you say, "pins," I assume you are talking about K-wires and not screws. K-wires generally sick out of the skin and are removed after their function is no longer required. At what point one resumes weight-bearing should be left up to the attending doctor. Pin removal is not a gauge of that.