lisfranc fracture

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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.

 

Hi,

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.

 

See my just completed response http://www.foot-health-forum.com/forum/showthread.php?t=585

 

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!

 

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.

 

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.

 

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.

 

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.

 

Hi there,

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.