I'm 30 and had surgery in july of 07 for my lisfranc fracture. I had a screw and kwires inserted. I had a few follow ups after surgery. I was finally able to get back to see my doctor after 8mths from our last appointment in oct to describe and show exactly where I have been having pain (almost extreme amounts) in my foot. He tells me that its then about time to remove the screw. That removal isn't urgent but should be done at least within a year in order to alleviate the pain. I was under the impression when he placed the screw in, that removal of the screw may be optional. Now it seems as though removal is standard operating procedure.
So, have all or a majority of those with lisfranc fractures had their internal screws removed?
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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First of all, Lisfranc injuries, which include ligament tears, dislocations and fractures come in a variety of grades or stages, so I have no clue as to which grade you sustained or exactly what surgical procedure was employed. The type of fixation used is at the discretion of the surgeon. It is generally the case that screws are removed, but the appropriate timing of the removal is a matter of on-going discussion, and is decided upon by the individual attending doctor's protocol. The screws are sometimes removed as early as a few weeks after surgery or may be delayed for several months. The thought behind the screw removal is that there will generally be some motion in the joints, and prolonged motion will often eventually cause a breaking of the screw with possibly chronic pain ensuing. I have to wonder, though, why it is that you did not get back to see your surgeon for 8 months.
My last visit was in October and just recently saw him because I was away at school. I felt uncomfortable seeing another doctor where I was at school because I didn't want someone new messing with my foot.
I kept in touch with my doctor during the interim about progress and what I should be doing.
I understand you can't give me a definite as there are grades and it seems this type of injury is all case-by-case basis. I was just under the impression that the screw did not need to be removed. So, when he told me that it may be time to take the screw out, I was a little taken aback.
I was just curious if generally the screws do come out and is not something that is permanent.
In all honesty, I believe that I covered your question of the propriety and protocol of the screw removal to the extent that was possible in view of my anemically little knowledge of your individual case, yet, unless I am misreading your response, you seem less than satisfied with or perhaps just unappreciative of my answer.
Not at all. You answered my question about the protocal and basic procedure. Thank you. You settle a little reservations and doubts I was having.
I originally posted because I was unaware that screw removal does happen at some point depending on doctor's discretion.
Thank you for giving me the info and I would have still been searching the web trying to get answers, so I am very greatful for this forum. thanks again
I'm please that I had apparently misinterpreted your initial response. Thanks for clearing that up. Everyone should keep in mind that the screw removal issue which I discussed is specific to the Lisfranc surgery and other surgeries which might cause undue stress on internal hardware by virtue of INTENDED motion. In most surgeries where implanted screws are employed for such as fixation for bony union, the screw is generally left in place unless complications dictate otherwise.
I had foot surgery back in April and the screws were removed 3 weeks ago. I am still walking with a severe limp and a lot of pain. I am just wondering how long it will take for me to be able to walk with out a limp and with little or no pain. I am trying to swim daily just to keep up some exercise, but walking becomes difficult as the day goes on. I am a teacher and I go back to work next week. Just a bit worried about my progress to this point.
Presently, I don't have any questions but thought I'd share my experience so far with a lisfranc fracture. My accident occurred on July 15, 2008. All the joints of my right foot were affected and was diagnosed as having a lisfranc fracture. 2 weeks after my accident (had to wait for the swelling to go down as my foot suffered much trauma) I had surgery. I was given an epideral and was able to hear and see some of the surgery when the 6 screws were put in place. I went through 3 casts and 1 aircast and was able to get back to work after 3 months (office/desk job). I have been going to physio, doing weights to strengthen my leg and foot again, laser and ultrasound treatments to help with the pain (but to be perfectly honest, I never felt real serious pain). My foot was stiffer than normal and noticed it more when I went down the stairs as it did not have the flexibility of my other foot. Though the swelling of the foot stopped, it still became inflammed in the top area of the foot where the screws were put in. My surgeon trhought it best that, because I am still young (great compliment since I'm 44) and active, that it is best that they come off as more complications would probably arise by leaving them in. So last thursday I had them removed and I did feel some serious pain after the general anesthesia wore off. There were some complications with the removal of a couple of the screws so a small incision had to be made. I've been able to walk on it (it's wrapped up in bandages) since the day of the surgery but surgeon though it best I keep it raised for 48 hours because of the swelling. I do walk on it though it is sore and try and raise when it swells up too much. So I'm working from home for the moment. I will know better with time but I did notice more flexibility on my foot when going down the stairs! So far, I can say that my experience has not been a bad one. There has been by far more good things come out it than bad. And besides, it could have been worse and have lost my foot completly or some other limb had I been cut off by a car instead of another cyclist ( I was riding my bike to work). Hope this helps someone...Sylvie
Just wanted to add to the forum my experience with my Lisfranc francture so far:
It has now been just over 6 months since I sustained my injury. Easily done, didn't see a step, was walking normally, bent my foot upwards etc.
Had a normal x-ray that night, obviously this didn't show my injury.
Was told to stay off my foot and a half cast was placed on my foot/leg.
After 10 days and more x-rays and CT scan to confirm the Lis Franc, I was fitted with a fibreglass cast on my foot up to just under my knee. I was not allowed to place any weight on my foot at all for the next 4 weeks. After appox this my cast was removed. I was fiitted for a hard plastic orthidic insert. I was not allowed to place any weight on my foot till my orthotic was fitted. In all 7 weeks before I was able to start placing some weight on my foot. Was told that I was not allowed to foot anywhere at all without my shoes. Total of 2 months off work also. Used cruches, then elbow cruches, mush easier to use, then a walking stick, after nearly 6 months now walking without aid. Still limping, trying to improve that.Still wearing ridged, due to remove this in 4 weeks. The hospital have said all the they can do, I am to keep going to physio. I still have pain, not unbearable but I am concerned, how long for? Lucky didnt have surgery but still dealing with problem, good luck to all injured! Good luck to me also!
Just wanted to add to the forum my experience with my Lisfranc francture so far:
It has now been just over 6 months since I sustained my injury. Easily done, didn't see a step, was walking normally, bent my foot upwards etc.
Had a normal x-ray that night, obviously this didn't show my injury.
Was told to stay off my foot and a half cast was placed on my foot/leg.
After 10 days and more x-rays and CT scan to confirm the Lis Franc, I was fitted with a fibreglass cast on my foot up to just under my knee. I was not allowed to place any weight on my foot at all for the next 4 weeks. After appox this my cast was removed. I was fiitted for a hard plastic orthidic insert. I was not allowed to place any weight on my foot till my orthotic was fitted. In all 7 weeks before I was able to start placing some weight on my foot. Was told that I was not allowed to foot anywhere at all without my shoes. Total of 2 months off work also. Used cruches, then elbow cruches, mush easier to use, then a walking stick, after nearly 6 months now walking without aid. Still limping, trying to improve that.Still wearing ridged, due to remove this in 4 weeks. The hospital have said all the they can do, I am to keep going to physio. I still have pain, not unbearable but I am concerned, how long for? Lucky didnt have surgery but still dealing with problem, good luck to all injured! Good luck to me also!
Wow. you have also had a time. I am 13 weeks post surgery, 16 weeks post injury. Still non wt bearing for another month?? I am concerned how it will go with starting to walk again, I am a nurse so i have to be on my feet all day and have a fair size unit to cover. I dont expect to be back too soon. What does physio have you do? I will not start until I can wt bear. Good luck to you, lets hope our outcome will be a positive one with no residual damage!!
Hi, just thought i would add my own experience and hopefully put my mind at rest!
I am 18 years old. I was travelling the east coast of australia when i fell from a wall, tearing ligaments and encuring a lisfrnc fracture in my right foot (not much has been explained to me by the doctors!). This occured about 5 weeks ago, one week later i had surgery. After a week of a soft cast my foot and lower leg was put in a hard cast. This is set to be removed in 3 weeks time. Then i've been told i"ll be given a 'moon boot' to start trying to weight bare. My injury is pretty much pain free and is yet to be servere since the night i fell. I am conserned however as i seem to read everywhere that screws and pins must be removed before full wieght bare and walking.
Does recovery time and removal of screws etc depend on each individual injury as i am hoping to return to my travels in august (3 months post op)?? I just seem to get such mixed reports.
Does recovery time and removal of screws etc depend on each individual injury
The reason that screws are generally removed in Lisfranc surgeries it that it is generally intended for motion to take place in the joint and this may cause hardware to fail and fracture. The timing of the screw removal is debatable and varies with the doctor. But, as always, the precise treatment of any injury is dependent upon the individual case and its nuances.
__________________ Foot Doc
Last edited by FootDoc; 10th June 2009 at 04:08 PM.
I sustained a Lisfranc injury in sept 07 after a fall from a vehicle, i had to wait 4 weeks for surgery due to the swelling. I had 2 plates fitted and 8 screws inserted ,after 8 weeks in plaster i had the cast removed and wore a moonboot for a further 3 months.During this time i had physio which contributed to 2 screws snapping off in my foot! This resulted in quite a lot of pain and discomfort and ceasing of physio.Due to the discomfort and swelling still occurring after nearly 2 years my surgeon wants to remove the plates and screws and insert wires in my foot, as the prognosis is not really known i declined the offer! Has anyone had a wire fitted as i would like to know the outcome.
Two years after .....had one of the best surgeons in my area. Truth is this is an injury you do not recover from. It does change your quality of life from this point on. Even if I try to stay off of the foot by the end of a day...the pain wakes me from my sleep.
I have been offered moree surgery of course....
Lets talk more about the arthritis that will set in to the injury and will not get better...it will only get worse. Yes you can take meds, wear otho inserts, buy expensive shoes, etc.
The quality of life and you activity level will never be the same. The pain will always be there and will only get worse.
I have given up on doctors, medicine, orthotics and all. I am focusing on how I will change my lifestyle to fit the injury that you do not recover from.
Any expectation that you do..is expensive and foolish. I am done throwing money at a problem that can not be solved.
Good luck to all of you and I can only hope that you medical plan is a good one.
It is interesting as to how so definitively and authoritatively you assert your solitary experience so as to accurately predict what all others will encounter. Would you feel comfortable with a doctor with similarly little experience as you have with Lisfranc's treating whatever other illnesses you might have? There are all degrees of severity of any injury, even serious ones, and just as many variances in the success of their treatment. It would certainly not have been inappropriate for you to have related your personal story, but to extend your gloom and doom to necessarily pertain to others as you have done is neither educational nor helpful.
__________________ Foot Doc
Last edited by FootDoc; 25th July 2009 at 02:26 PM.
I recently was in a auto accident, injured my right foot and hand. It happened in Dallas and I live in Kansas City. Now, 4 weeks after the accident, I'm learning how serious my injury is.
I will learn more tomorrow, as I finally see the only surgeon in my area that can possibly help me. I'm not sure how severe my foot is, has been termed lisfranc, space in my joints fractures, dislocation etc. I'm terrified. I can't bear weight.
I just want to say thank you to all who have taken the time to post comments. I don't fault anyone for being boldly honest about there situation. If someone has been through hell, and isn't seeing any results..I'm o.k. knowing. I appreciate knowing. Deeply greived for the person and possibly myself. Yes, everyone is different, but sharing personal experiences and even opinions is very helpful to all of us. I have faith, I know and believe God can do amazing healing. Right now, I find it helpful to read any and all info to gain some insight on my situation. I'm holding all of us in prayer. Thank you to everyone. Post it all and let us discern for ourselves the info.
There is nothing wrong with posting ones individual story. What is wrong is when someone, based on his individual and solitary experience, makes assertions which he/she presents as fact, such as, "this is an injury you do not recover from." That is neither necessarily accurate nor helpful, and is certainly unnecessarily discomforting . . even cruel to someone who has recently suffered a similar injury. Unfortunately, these folks offer their personal and generally singular experience as if they were experts on the matter, and that in my view is a disservice to anyone who comes here looking for a realistic prognosis and reasonable and responsible advice. The fact that you, personally, may be able to see through such assertions and realize their lack of general basis is neither excuse nor consolation for the poster having posted them.
__________________ Foot Doc
Last edited by FootDoc; 27th July 2009 at 06:36 PM.
I just thought I would share my experience and hopefully answer some questions I have.
I suffered a lisfranc fracture on May 16th. I had surgery on it one week later, in which 4 screws and a k-wire were inserted. The whole injury has been fairly pain free, other than the night it happened (fell off a wall) and for about 3 days post-op. 2 weeks after the operation the partial cast which allowed for swelling was replaced by a hard cast for a further 4 weeks.
6 Weeks post-op the cast was removed to reveal a bit of a state - my foot was purple, oddly shaped and achey to move. I was told that before any weightbare I would need the k-wire removed but the screws would remain. So 1 week later the k-wire was removed and I was given a follow up appointment 2 weeks later.
I was given a moonboot which I am currently still in. I'm partially weightbaring with crutches and moonboot, since doing so my foot has flattened and improved in the way it looks. I'm told I will be able to fully weightbare and walk un-aided after 3 weeks in this boot, as that will take me to the 3 month mark.
I'm wondering what I should expect when it comes to walking without the moonboot? Do people find a drastic difference in the moonboot stage? I am returning home to the UK when I can walk and would like to be able to catch up with friends, drive and return to work before the end of August.
I would be very grateful for any advice. And good luck to everyone else that is dealing with a lisfranc injury!
It is difficult enough even in a patient whose precise injury and the exact nature of the surgery is known and an estimation of the patient's tolerances has been made to predict the course and tolerance of care, much less someone who has related only cursory facts such as have you. It would be especially unwise to take as necessarily pertaining to you the anecdotal reports which you might obtain from posters and former patients who know none of the above or how similar their situation might be to yours. You would do best to rely on opinions from those who are attending your case, as most traumatic cases are individual events with particular nuances of their own.
I sustained a lisfranc injury to my right foot in a car accident on June 27th. I was lucky that the doctor diagnosed it as a lisfranc fairly quickly after seeing that I couldn't weight bear and had a CAT scan done. I had surgery 5 days later, which involved 3 screws. I was in a cast for 6 weeks (non weight-bearing), and had a custom AFO fit that I received this past Friday (Aug. 14). I'm told that I have to wear the brace for 6 months, and that the screws will come out at that time.
I'm not really offering or asking for advice, I just wanted to share another point of view that everyone's injuries are different. When I asked when I would be fully weight bearing and walking without crutches, I was told that basically I'd be walking around one day and realize I wasn't really using them. I'm trying to walk a little day-by-day and at least put some weight on it. I haven't really been in pain since a week or so after surgery. Now I'm just sore and weak. I hope to be back to work in another few weeks, at least part time, but that will mostly depend on when I can walk, and no one really has a definitive answer for that.
Do most people get PT for a lisfranc? The surgeon said mostly likely I won't need it, but the therapist that is working on my whiplash said most certainly. Any thoughts?
i have read through most of the posts and hoping you may have an answer for me aswell. my bf was in an accident at work (sept 20th 2008) where a backhoe ran over his foot. long story short he has a listranc fracture. he went for surgery and had 2 screws and 2 pins in his foot. they removed the pins, and left in the screws. he had to go to the hostpital to get xrays and a specailist appt today and they informed him that a screw is broken in his foot. It is one year almost after the accident, and he is goin to have to get the screw removed. my questions for you are,
do the screws break often?
should they be fixing it a year after the accident?
why are they goin to fix the screw and not remove it?
what can we do to prevent the screw from braking again?
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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Most often screws are purposely removed shortly after Liscfranc's injury surgery to prevent their breakage, as unlike many applications where hardware is implanted and left in place permanently, there is generally intended for there to be motion at or very near the screw site in Lisfranc's injury surgery, giving rise to the possibilty of hardware failure after its purpose has ended. I don't know how a broken screw would be fixed, and as you indicate that he is going to have the broken screw removed (which may be easier said than done) why are you asking why they are going to fix it instead of removing it? As I stated, the screws are generally removed to prevent their breaking and that's the best way to prevent a boken screw.
I was dancing ballet as is my hobby when i injured myself on july 14 coming down from a landing and hearing a snapping sound and falling to the ground. i could not walk. i immediately went into shock and the emergency room but did not actually feel pain right away. the er doctor could not find anything wrong with the xray but could see by the state of my foot and the swelling that something more serious was definitely wrong. she said i had broken a bone in my foot and put my into a splint up to my knee.
i went to a specialist who deals with dancers, who was able to diagnose the lis franc injury a week later and had told me that i had not broken a bone at all. He then referred me to another doctor who could help me with this specific injury and I found myself in surgery 2 weeks after the injury had happened. In not only dancing, but landing, I had managed to dislocate many bones as well as snapping the ligament in half. They have been really great in explaining to me what they were doing and are realistic in the time this could potentially take to heal....3-6 months in my case depending on the regrowth of the ligament. Two weeks following surgery (putting me at 4 weeks here) I had been in a plaster cast to allow for swelling. Now I have been in a fiberglass cast for 2.5 weeks and I have 1.5 weeks to go before I swap over to the moon boot (putting me at 8 weeks here) with physical therapy.
I am unsure how long I will have the moon boot and physical theraphy for, but within 8 weeks from the moon boot I am told I will have screws pins and plates taken out so that I can return to dancing eventually. I won't ever do ballet again, but I can pursue contemporary.
I do not know how the recovery goes after the second surgery...obviously it varies here, but does anyone know if i have to do the splint, followed by the plaster, followed by the fiberglass, followed by the moon boot all over again? or at a shorter span each cast? If not, I foresee this lasting until christmas which will take me 6 months from start to finish. If I can walk a week or two after the screws come out, then Halloween!
I am excited that the doctor says I will dance again, and I have heard that many dancers that have this injury do, so fingers crossed.
Just wanted to relate my experience and hopefully encourage others going thru this that a good recovery is entirely possible. I sustained my lisfanc fracture of my right foot in July 2006 as a result of a jetski accident - I struck my right foot on the ski when I was thrown off. I underwent surgery approximately 2 weeks later with 2 screws & 2 wires. I was in a moonboot but non-weightbearing with crutches for about 8 weeks, followed by gradually progressive weightbearing. I had the wires removed in November and was fully weightbearing with no assistance before Christmas. I had the screws removed the following February. It took some time, approximately 1 year before I was totally pain free; and by pain I don't mean incapacitating, but mainly pain when first walking in the morning and at the end of the day. The only time I have any discomfort now is if I go dancing with my husband and it doesn't hurt while I'm dancing, just the morning after for a little while. The only other thing is that I have trouble fitting some shoes on that foot due to a lump, which I assume is perhaps excessive bone formation at that first joint. I also never had to have any physical therapy but did wear an arch support in my shoe for the first 12 - 18 months after becoming weightbearing. Now I don't even need it. I hope this gives everyone encouragement.
I have recently suffered a lizfranc injury and stumbled upon your site. I find it conforting to see persons with similar stories but I am a bit frightened of what my future may be. I suffered my injury on August 12th as I was coming down the stairs in a long dress and the heel of my shoe got caught up in my hemm and I twisted my foot and fell down six steps. After an emergency room visit, visit to a orthopedist I was finally refered to a Foot surgeon who informed me it was a severe injury. I fractures all five of the metarsals as well as tore two ligiaments. I had surgery August 26th to which a plate, several screws and a pin that sticks out of my foot were inserted. I was sent home 2 days later with pain beyond belief. I was taken out of the hard splint 2 weeks after surgery and the stiches removed and placed in a night split that allows no weight. I was cleared to go back to work (work behind a desk) with crutches but they are killing my arms, shoulders and back. The simplest tasks are frustrating and this injury is serevly limiting my ability to be a parent to my three young children (one 5 and two 16 month olds). My doctor will not give me a straight answer on when I can move on to either a partial weight bearing boot or full walking boot. Now I may have to have surgery AGAIN to remove screws (which he also did not tell me about). Is removal always done? Will I ever progress forward? Is my quality of life forever affected?
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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It would be foolish and irresponsible of me to comment upon whether and when you should be weight bearing. That should only be determined by the attending and may differ from case to case. But as regards the screws, Lisfranc's surgery is one in which the screws are generally removed, although the timing of their removal is up to the attending doctor. They are generally removed because, unlike surgeries where there is not intended to be motion at or near the placement of the screw, that is not the case with most Lisfranc's surgeries and the anticipated motion can cause fracture of the screw which can them produce all new problems. No one without knowing you and assessing your case can responsibly offer you the prognosis you request. Your own doctor should be better suited to make such an estimate.
Back on July 22, I twisted my foot stepping off a 4 foot ledge. CT scan diagnosed a "Divergent Lisfranc fracture-dislocation". The base of my 2nd metatarsal (the longest bone of the arch, or mid-foot) was "comminuted", meaning shattered into many pieces. In addition, there were "avulsion fractures" of the cuneiform and cuboid bones, meaning that ligaments have torn away, taking pieces of bone with them.
The first ortho (referred by my Workman's Comp) didn't cheer me up. He was holding up a foot model and showing me where he was going to "fire a pin" here, and "fire a pin" there, in order to stabilize the foot. But he says, "I want you to be aware that you're going to have a bad foot regardless. You're probably are going to feel pain from here on out. How much, will remain to be determined. But this is a very serious injury, a very high energy type of injury that I see from auto-accident victims, parachute jumpers, falling thru ceilings, etc. Don't rule out the possibility that you'll walk with a limp after I've done all I can do. If the pain gets too unbearable, I might have to do a bone fusion. But right now, I have to get in there and try to reduce the amount of arthritis that will set in." But he says, "it will be a couple of weeks before I can operate until the swelling comes down." But they sent me home without my foot wrapped, and didn't tell me to put my foot up or anything.
Well, something didn't feel right about this ortho, so I called a family friend who is a physician and explained what this ortho wanted to do. He investigated and came back and said that for my injury, I needed a foot and ankle specialist, not someone who just 'dabbles' in it, while doing knee reconstructions and shoulder replacements.
He referred me to a foot/ankle doc who he said specializes in Lisfranc injuries. I got an appointment with him on the day two weeks after the injury. He said he needed a new CT scan because the previous one ordered by the original doc didn't have the all the views, but that he couldn't do surgery anyway because my foot was swollen up like a balloon. He sent me home and told me to come back a week later, and this time they finally wrapped my foot up and told me to keep my foot higher than my heart, and ice it down to bring down the swelling. I go back a week later, and he saw that the swelling had come down enough for him to do surgery the following week.
So, 4 weeks after the injury, I undergo surgery. He put in a plate with 4 screws to line back up the 1st metatarsal. He found the base of the 2nd metatarsal blown into little 'chicklets'. He extracts them all and mixes them together with a bone graft that he takes out of my heel, and packs it into the area where the 2nd metatarsal base used to be. He installs a second plate with 5 more screws, and along with 3 more long screws laterally to create a "scaffold" for the new bone to grow. He then fused the entire Lisfranc joint between the 2 plates. Thank God they put a nerve block behind my knee!
That's 2 plates, 12 screws, a bone graft, and a fusion.
I went back last Thursday (two weeks post-op) to get that splint off and the stitches removed. That's when he showed me those post-op medieval looking x-rays. Most of the pain, except for pretty bad twinging, has gone away, but I still need Vicodin to sleep. They put on a new fiberglass cast, and told me to keep my foot up in air for the next 4 weeks. Whenever I have to get up and hobble to the bathroom on my crutches, or go out to the kitchen to get a drink of water, my foot instantly inflates like a balloon like someone's using a bicycle pump, and turns deep purple. I'll feel a lot better mentally when it stops doing that.
I'll keep posting as it seems from reading others' stories, that this is going to be one long journey.
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I certainly cannot assess the relative competence of the two surgeons you saw nor the severity of your specific injury nor its individual prognosis, but I think that you were probably more off-put by the first one's up-front offering you what he believed to be reasonable expectations than anything else. I likewise cannot say if his assessment was correct, but too many doctors fail to prepare their patients for the honest fact that, like with Humpty Dumpty, all the King's horses and all the King's men can't always put everything back together again . . . at least, not how it was before the trauma, though I sincerely hope that does not turn out to be the case for YOU. Good luck!
__________________ Foot Doc
Last edited by FootDoc; 22nd September 2009 at 01:32 PM.
I was more put off, or to be more truthful about it, my family physician was more put off with the "firing a pin" explanation than anything else. He didn't see how, considering the severity of the injury, how you could carry out an effective surgical repair without using plates, screws, and bone grafts. He wondered to me aloud, "how could you fire a pin into a comminuted fracture?"
As far as expectations go, the foot and ankle doc who did the surgery on me, advised me beforehand that I will never have the foot that I had before. I know I will walk with a limp for the rest of my life. I've accepted that.
But, when you consider that for the past two months being confined to the house, when the only way you can go to the bathroom, or go to the kitchen to get a drink of water, or go get in bed, is by using crutches, or crawling on my hands and knees, hey I'll take anything I can get. Long term goal . . . if I can get to the point to where I can walk up the stairs in my 2 story house, I'll be good with it.
If it sounds like I'm depressed, I am. Who wouldn't be? And these forums are a two-edged sword, BTW. It's nice to know that there are other people who have this kind of injury. OTOH, the stories don't really do much to cheer me up.
lisfranc fracture
Re: lisfranc fracture
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