Lisfranc Injury

[amyg810]

I suffered a lisfranc injury on 11/9/08. Actually, I didn't find out it was a lisfranc injury until around the 14th. On the 9th I went to the ER and was told I had fractured my third metatarsal. Followed up with an ortho PA on 11/11 who suspected a lisfranc injury (and also found a fracture on my second metatarsal) and sent me for a CT scan on the 14th. Saw a locum in the office on the 18th who advised that the dislocation was borderline as far as whether or not surgery was needed. He advised he was going to go over it with the ortho surgeon regularly at the practice and see what he thought. Got called into the office on the 20th by the PA who advised the regular surgeon also didn't feel comfortable making the call on whether or not to do surgery so they sent me to a podiatrist/ surgeon on the 24th. HE advised me that the displacement was 2mm and he could get it as "close to normal as he could" with a clamp. Weight bearing x-rays that day showed no shifting, everything was staying in place. I have absolutely no pain, even when attempting weight bearing. I couldn't bear the though of being on crutches for another 10-12 weeks so I opted not to have the surgery. I've been non-weight bearing for 3 weeks. I am currently in a short-leg non-weight bearing cast until 12/10.  That day, they will be removing the cast for more x-rays. I had no idea what decision I should have made and had read plenty of horror stories about problems related to surgery before I saw the specialist. Is the fact that I have no pain a good sign? Is my injury minor or should I have gone with the surgery? The specialist pretty much left it up to me and didn't caution me either way which is what made this so confusing for me.

[Yena H Do, DPM]

i typically would fixate a lisfranc's injury.  the displacement occurs when the ligaments rupture.  fixation with screws help hold everything in place while the ligaments repair.  you will be jumping, running, etc and your feet will need to withstand that.
if you have a displacement, stay off the foot for the recommended time or you can have pain in the future from inadequate healing of the ligaments.  as for the toe pain, you may have injured it but not realized it b/c you were focusing on the lisfranc injury.  have it looked at again by the surgeon.

[amyg810]

:( Now the base of my second toe hurts which is nowhere near where any of my fractures are. *sigh* I just want to be better now! lol

[amyg810]

Ok, well, back from the doctor (again). Took another set of x-rays which still show  no shifting so I guess that's a good sign. I'm still non-weight bearing until another follow up on the 22nd (MORE x-rays that day). According to what the doc today read to me from the podiatrist's notes, if I understood it right, I think I'll be able to start putting weight on it then? That will be six weeks post-injury. I got him to take off the cast. It was way too uncomfortable in that it was rubbing/ weighing down on other spots on my foot and ankle. It sounds weird but I feel a lot more secure in the boot. I've had a couple falls and close calls with the cast on that felt like it wouldn't have been as bad if I had had the boot on. It was a little wierd though. Looking at my x-rays today it almost looked like my first metatarsal was more crooked than it was before. The crack in my third metatarsal looks like it could be getting better? I don't know, it seemed like the line that is the fracture wasn't as black as the x-rays from the night I injured it. Hopefully I'm on the right track. I'm to wear the boot all the time (as if it were a cast I guess). But for some reason I definitely feel more secure in the boot than the cast. I didn't get a cast until two weeks into my injury so in my mind I guess I was thinking that since by now it seems to be healing I should be ok with the boot. Hopefully I'm right. I plan on being very careful with it so I don't make it worse.
Just how long does it take for a ligament to start healing? I haven't been able to find that anywhere. And... would taking glucosamine chondroitin help anything?

[amyg810]

Oh, another question... when a patient decides against surgery at what point is weight bearing usually allowed? Or does it go on a case by case basis? I'll be seeing my doc next week at six weeks post injury and I'm SO anxious to get off these crutches (still no pain).

[amyg810]

Back from my six-week check. More x-rays still showing no shifting. Thankfully, I was given the green light by the orthopedic surgeon to start walking on it. He said that since the displacement was only 2mm, I will most likely do just as well without having had the surgery, which was a huge relief. Of course, he's a guy that does mostly knees and carpal tunnel surgeries, but he's been around a while and I trust him. I'd been doubting my decision since I made it but I finally feel for certain that I did the right thing. I've been walking on it since last night (even did a little shopping). I was a little sore but it was nothing that a little advil couldn't take care of. Just having my mobility back is a huge boost. I go back in 3 weeks now for another set of x-rays to make sure it hasn't shifted with weight-bearing, probably a final x-ray 3 weeks after that. I've been instructed to wear the boot for another six weeks, but I don't care, I'll wear the boot till the fourth of July if it means not being on crutches. Just want to say a quick thanks to the docs on this board. You guys are really helpful! :)