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Lisfranc ligament rupture

Discussion in 'Ask your questions here' started by dazzer, Oct 16, 2008.

  1. dazzer

    dazzer New Member


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    Hi There Foot Doc

    About 4 weeks ago I had an open reduction on my big-toe tarsometatarsal, closing the gap thus allowing the ligament to reform. I understand that for this to happen properly it takes about 3-4 months for the ligament to reform so until then I cannot weight-bear at all. The op went well, only requiring one screw to put things back in place.

    My surgeon talked about scar tissue reforming, does this simply act as the reformed ligament or will the ligament in the crucial area completely repair itself? The injury was incurred 10 weeks before the op took place if that helps.

    Also, I have slipped on my crutches once or twice, resulting in me putting my bad foot down on the floor for a split second. On those odd occasions I reckon I have placed no more than 30% of my weight on said foot, will this have messed up my recovery or set me back at all? The foot felt ok and pain free each time I have inadvertently put some weight on it if that helps

    Lastly, I am being told only after the removal of the titanium screw occurs will I be able to even partially weight bear. Can you give any indication of how long recovery to point of being able to play squash again will take, post screw-removal? I am a 35 year male is reasonable health.

    Any light you can shine on this is much appreciated, and I do understand that each case is unique, therefore making it impossible to be 100% accurate.

    Many thanks
    Darren
     
  2. FootDoc

    FootDoc New Member

    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.
    ***********************************************************
    Of course, I cannot speak knowledgeably about your specific case, but I can attempt to address general issues and principles of treatment which may or may not intimately pertain to your individual situation.

    I really cannot say whether you have related the story from your doctor as it was actually intended for you to understand. First of all, I don't know what you are trying to relate with, "I had an open reduction on my big-toe tarsometatarsal." as, first of all, I don't know what the big-toe tarsometatarsal is, and secondly, an open reduction is a treatment for a fracture, not a ligament rupture, and thirdly, the big-toe is no where near the Lisfranc joint. So, I am are starting off with a great deal of confusion as to what you are stating.

    Next, there is no such thing as a ligament "reforming." If the ligament segments were in good approximation, there might be healing by fibrous scaring (if you are lucky), as most tissues in the body heal. But the best course, when healing of a ligament is essential, is surgical repair. In either case, the healing interface site will consist of fibrous scar and not ligament tissue, although in the case of a surgical repair, there should be less scar tissue. Scar tissue is inelastic, while ligament tissue IS elastic, and much of its function depends on that elasticity. If surgery is require for ligament repair, however, it generally must be done almost immediately for best prognosis, and not 10 weeks later.

    Unlike many surgeries where screws are employed for fixation and they are intended to be left in permanently unless there are complication, in Lisfranc surgeries, the screws are generally routinely removed within a relatively short period of time after surgery as determined by the individual doctor. The reasoning behind this is that after such surgery it is intended that there be motion, not fusion, and it is generally feared that this expected motion will cause the hardware to eventually fail. So it is generally removed before that can occur. It would be irresponsible for me to suggest to you how long the recovery period will be, as I have no idea as to the state of the original injury, what other concomitant injuries occurred, precisely what surgery was done, how skillfully it was performed and the state of your general physical condition.

    It would certainly not be possible for me to say if you did any damage with your slip, but I think it is safe to say that you did no good with it. This should have been immediately brought to the attention of your doctor so that HE/SHE could make the assessment which you ask here.

    Finally, you have a doctor whom you have engaged and are probably paying. He/she is far more familiar with your situation and treatment than anyone who might give you an opinion, and especially without an examination. Why are you asking all of these essential questions here rather than to your doctor?
     
    Last edited: Oct 16, 2008
  3. dazzer

    dazzer New Member

    Hi there foot doc,

    Thanks for getting back so quickly, much appreciated.

    I am of course in a good relationship with my surgeon and will speak to him in due course, my next appointment is on the 3rd of Nov, just want to gain more insight before seeing him...there's no harm in asking another expert methinks.

    I know the big-toe is nowhere near the lisfranc joints, it's simply my untrained way of explaining which part of the tarsometatarsal complex I'm referring to, i.e the main one nearest the instep of one's foot. (I've most likely not made it clear again, sorry:confused:) Also, I was told I had an open reduction, perhaps I miss-heard, perhaps I've had an anatomical reduction? Anyway, I'm hoping you know what I mean.

    Moving away from my particular case, can you explain more about the healing by fibrous scaring? Is it possible to have a full recovery of this ligament after surgery? Not necessarily in my case but as a best-case scenario given surgery is necessary to close the gap.

    Again, thanks for your input and i do understand that to a certain degree you are constantly being asked questions with almost nothing (Useful/accurate) to go on. Sometimes I'm sure it's like being asked how long is a bit of string:confused::confused:
     
  4. FootDoc

    FootDoc New Member

    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 the treatment technic termed "reduction" can apply to relocation of a dislocated joint, "open" reduction almostly exclusively relates to setting a fracture by surgical means.

    Most tissues in the body (bone is generally an exception) when closely approximated after injury heal by fibrous scar, where, through a process involving several stages, the interface between portions of torn tissue is replaced with non-specific scar tissue which is a fibrous tissue that is often derived from a different embryonic tissue than the tissue which it is repairing. This fibrous scar tissue's only function is to join the two severed or damaged portions of the original tissue, and it does not have the same characteristics as the original tissue. The fact that one can see a scar on the skin after a suture repair is an example of this.

    As you seem to understand, my efforts here are directed toward helping questioners with GENERAL understanding, and neither represent nor should they be expected to represent a consultation or second opinion which would ordinarily require a physical examination and, as you note, far more and specifically worded details.
     
  5. dazzer

    dazzer New Member

    Very intersting and infromative, thanks a lot Doc.
     
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