lisfranc fracture

Hi
I suffered a lisfranc in Jan/09 and am still non wt bearing until after screw removal in May 09. [I hope} It has been a long haul of sitting on my bottom and I am looking forward to even standing again. I have an occasional ache but no pain and remain in a air cast which I remove twice a day to do range of motion exercises for my ankle. I have limited toe flexion yet. My question is... Is the discomfort after screw removal as bad as the original sugery, will I have to be put out for it and how long after before I can start to wt bear?? I am also wondering how progression to walking usually goes. Thanks for any info you can give me.

[FootDoc]

DISCLAIMER:
THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
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Although pain is a very subjective matter and varies greatly from patient to patient even when undergoing essential the same procedure, unless complications are encountered, the screw removal is generally not especially painful for most patients. As was the case with the original procedure, the screw removal can certainly be perform without general anesthesia, employing either spinal or even local anesthesia, depending upon the skill and experience of the surgeon in using non-general anesthesia. Why have you not discussed this with your own doctor? Post operative direction and expectations should be obtained only from the attending surgeon.

Originally Posted by FootDoc

DISCLAIMER:
THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
************************************************** *********
Although pain is a very subjective matter and varies greatly from patient to patient even when undergoing essential the same procedure, unless complications are encountered, the screw removal is generally not especially painful for most patients. As was the case with the original procedure, the screw removal can certainly be perform without general anesthesia, employing either spinal or even local anesthesia, depending upon the skill and experience of the surgeon in using non-general anesthesia. Why have you not discussed this with your own doctor? Post operative direction and expectations should be obtained only from the attending surgeon.

I am simply looking for broad answers. I realise that treatments and expectations are individual, I am curious what most experience. I have asked the questions but he is reluctant to give me straight answers. Either because this is not usual type fracture or because I also had ligament damage, c ompounded with shattering when he put in the screw. I have tryed to get 'norm' answers but the most I got was that screw removel in May if all lookes good on my Xrays this week. As you must understand, after 16 weeks of no wt bearing, I am anxous to move on and stand again. I simply need a marker to base recovery on. I will be asking again this week and hopefully I can pin him down a bit. My work is also anxous to know when I may return so always are looking for estimated updates or progression.
Thanks for the answers, I will find out if he will use local or.... for removel this week as well

[FootDoc]

I would assume that you posted your question in order to receive a response on which you might rely. But if your own doctor who performed the procedure is reluctant or unable to give specific answers because you believe that yours may have been an atypical case, what could you possibly gain in the way of either comfort or despair from the anecdotal report of someone whose situation may have been totally different than yours or even a doctor who doesn't know your situation? But why guess on why you aren't able to get "straight" answers? . . Ask your doctor what his/her reluctance is all about, and don't leave until you find out. Your doctor is YOUR employee, not your boss. It is HIS/HER responsibility to please YOU. That's what you're paying for. So demand it.

Three and a half years ago I suffered a Lisfranc fracture and dislocation when I (stupidly) jumped from a high height off of a catamaran boat into the sea and landed in shallow water. I was in Venezuela on vacation and the catamaran had no first aid kit, no meds, just ice and straight dark rum! My friends fed it to me telling me it was rum and coke as we watched my foot swell beyond recognition and kept putting ice on it until we could get back to the mainland, 2 or 3 hours later. We were sent to a free clinic (scary place) where they told me that my foot was not broken because they couldn't see it on the x-ray but that I probably tore ligaments (I did, but that was not all). I was given a half cast, wrapped in bandages and a prescription for some super strong pain killers. Had to figure out how to get crutches... our Spanish vocabulary was not that advanced at that point. Our hotel kept sending us towels when we needed a wheel chair. Ended up flying back to Bogota, Colombia (where I lived) teaching English, about 3 days later and spent the next day in the hospital there. I was lucky enough that a Harvard trained foot surgeon was on staff that day and he took my case. He told me I had a Lisfranc fracture dislocation after examining, doing weight bearing X rays (killer) and CAT scans. I had crushed my foot and my 1st and 2nd metatarsels were in pieces all around the cuniform bones. THings had shifted (dislocated) as well. He said I probably tore ligaments and since I didn't receive proper medical care immediately, my foot had become so swollen that it cut off circulation to my toes. I now have nerve damage to my big toe (no big deal, but annoying when you step on a cold floor and it zaps you!).

So, I was told I would probably need surgury but at the time I was 26 and scared out of my mind to go through that living in a foreign country without my family nearby. I was already wondering how I was going to manage. So my doc let me opt out of it. I had a non-weight bearing cast from mid April to the beginning of July that year. Thank God for good friends! Teaching was a challenge, let me tell you! In July, I flew back to Canada and saw an orthopedic surgeon here. He removed the cast, put me in a walking boot cast and told me that I still might need to have surgury in the future. I was in the boot cast until September and then wore only orthopedic running shoes until December of that year.

I haven't been able to wear heals, don't trust my foot to move properly if I have to run across the street, and I have definite aches when it is about to rain or it is cold. I am pretty good though! I can walk and I've been going to the gym, on the olyptical. Everyday life is good without having the surgery. If I am standing or walking for a long time, my foot hurts. I do think I have arthritis in my foot. It is VERY stiff in the morning and it is hard to walk down the stairs. I think the shape of my foot changed as it is hard to find shoes that fit my high instep. I don't know if having surgery would have been better - I've heard horror stories from that too. It's obviously not better even after 3 and a 1/2 years but I'm not sure having surgery now is the best option either. Fusing bones together seems pretty drastic and I DO NOT want to spend another 3-4 months in a non-weight bearing cast!!! THAT was horrible. (I got good biceps though!)

There are very few posts out there with people who haven't had the surgury, so I thought I'd tell my story. Hope it helps. If you have any advice for me I'd also appreciate it!