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Story of my Lisfranc injury...so far

Discussion in 'Ask your questions here' started by towermethod, Jul 24, 2010.

  1. towermethod

    towermethod New Member

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    hello all! I was recently diagnosed with a lisfranc injury so I was doing some research on it and found myself on this forum. I thought I would share my story with you since so far it seems to be going a little different than most lisfranc-type stories I've found. I'm not looking for any medical advice specifically, I have a doctor for that. But all input, opinions, or insight is welcomed and appreciated! It's a bit long so here we go...

    I am 20 years old, healthy and active. I was at work when I fell straight on to my right foot from several feet in the air (I was also wearing sturdy, steel-bottom boots). Immediately, there was significant pain but I was hoping it would be one of those things that would subside with a little bit of rest, so that's what I did. I live a pretty adventurous life, so I've seen my fair share of breaks and tears from activities like ski racing, climbing, etc. I try to tough most injuries out, but something did not feel right about this foot. I gave in and went to the hospital a few hours later. It's important for you to know that this is all being covered by worker's comp.

    The hospital took several x-rays and said that they maybe see a fracture but they weren't sure so they sent me home with crutches and an ace bandage and told me to follow up with an orthopedic doctor. Over the next few days, my foot blew up like a balloon and changed all sorts of colors. When I went to the orthopedic doctor, he examined the x-rays from the hospital and saw no fracture. He said that he would take an x-ray in a later appointment which would allow him to confirm or deny a fracture. He initially diagnosed it as a contusion and gave me a walking boot. I continued treatment with this doctor even though my appointments kept getting delayed because he cancelled several appointments on me. First red flag for me. When I finally saw him again more than 3 weeks after the injury, he told me I could go now stop wearing the walking boot and asked if I was ready to return to work. I said no because I could barely walk even with a limp and my job is very physically involved so he agreed to hold off on that. Per his orders, I began walking without the boot. It was a struggle at first but each day got better. When I saw him again (5 weeks post injury) he told me that he was clearing me for work and I again asked him to hold off because I didn't feel comfortable with that. He ignored my wishes and cleared me for work. Second red flag. I then asked about the x-ray he said he would take. He talked his way out of it (so he never took a single x-ray throughout the entire treatment). Another red flag. The status/post diagnosis was left as a contusion.

    At this point, I was walking with minimal pain, although I did have a weird hop in my step but I wouldn't quite call it a limp. Pain only came from an unusual step or if something knocked into my foot. However, something still didn't feel right about the whole situation and the first doctor raised numerous red flags and really made me question him. I don't want to make any assumptions but I honestly think the doctor was trying to get rid of me or play my injury down for some reason related to worker's comp. If this is the case, I am truly offended that he would compromise my health for that.

    Anyway, I decided to pursue a second opinion with a doctor who had treated me for previous injuries. My first appointment with him was about 7 weeks post injury. I brought my x-rays from the hospital and pictures that I had taken of the foot in the days following the injury. Just by looking at both of these and quick physical examination, he was almost certain that I had sustained a lisfranc injury. He took a few x-rays and confirmed several ligament tears in the area as well as a fracture. I also fractured the cuboid bone. He showed me how the space between the bones in the lisfranc region were separated/widened, but I'm not sure if this translates into significant dislocation. Honestly, I was so overcome with the significance of this injury and how much more severe it is that "just a contusion", that I didn't get the chance to ask specific questions. My concern grew as he explained the severity of this kind of injury, the possible need for surgery, etc. Per his orders, I just got fitted for special insoles for my shoes and I will be going for a CT scan in a few days. He also removed me from work for at least the next 6 weeks.

    Now I'm not sure how severe my lisfranc injury is compared to everybody else's, but the doctor made it seem rather significant (and usually when I get hurt, I really get hurt), he was explaining it like it was a really big deal. What is odd to me is that people have been saying they have extreme pain for several months after the injury. As for me, I am walking around with no pain (although I still think I have a little bit of a hop in my right step) and it only aches every once and a while for no more than a minute at a time. It is also sore every morning but goes away quickly. I even began bearing weight on it (without the boot) around 3 weeks post injury. The doctor also said I am walking on it far better than he would expect based on my x-rays. And while that is all good news for now, I will find out more at my next appointment in 2 weeks.

    Honestly, my primary concern is that my injury was not even close to being accurately diagnosed until 7 weeks into the healing process. I'm afraid that things may have healed in the wrong place or incorrectly and because of this I will need surgery (although I have not been formally told this by my doctor). Also, I cannot say for sure, but I'm almost positive the first doctor knew something was seriously wrong but avoided any tests that would prove it. It really upsets me that he thought he could pull that off and send me on with my life and a messed up foot. And I'm not trying to speculate or psyche myself out, but surgery right now would surely put a damper on my upcoming ski racing season! Hopefully everything turns out okay, I can update as things progress. oh and sorry for writing an entire novel here, thanks for reading!
    Last edited: Jul 24, 2010
  2. FootDoc

    FootDoc New Member

    It is not at all uncommon for the diagnosis of especially a mild Lisfranc injury to be initially missed. I would be shocked if your suspicions about your first doctor are correct, and if you have read some of my responses, you would know that I am not one who reflexively takes up for doctors.
  3. rothane

    rothane New Member

    Only 7 weeks? Try 19.

    My lisfranc sprain occurred on 2/28/2010 and wasn't diagnosed until 7/16/2010. This was partly due to apathy on the part of my primary care physician, who kept blowing off my concerns and just telling me to stay on the crutches a little longer. She told me that it couldn't be serious because the x-ray (non weight bearing) hadn't showed anything. I finally got angry enough by late June that I asked to see another doctor in the practice for a second opinion. He ordered a battery of new tests and sent me on an emergency appointment to a podiatrist (who didn't diagnose me but helped me get some of the more maddening nerve symptoms under control). That helped tide me over to the one positive thing my first PCP did, which was refer me to an orthopedist (although that appointment took two months to get into).

    And guess which one of them is now my primary care physician?

    In my case, it was particularly annoying because I brought up the idea of a lisfranc injury back in May. I had brought a picture from an online article that showed the lisfranc area of the foot, and tried to hand it to her, and she actually shoved it back at me and said, "No, I don't want to see that." My former PCP never once even physically examined my foot -- just gave me crutches after the initial injury, or rather, had her nurses do it because once the x-rays came back negative, she seemed to lose all interest in the case.

    I was particularly upset to learn that in cases of orthopedic injuries, I could have gotten a referral to an emergency orthopedic appointments within a week of the initial injury, but my former PCP never even mentioned that as a possibility to me. The second doctor asked me why I hadn't gone for the emergency appointment, and unfortunately didn't seem too surprised when I told him that my old PCP had not informed me of that option.

    If nothing else, I've learned not to be too passive in my health care anymore.
  4. FootDoc

    FootDoc New Member

    GOOD FOR YOU! If you have read a decent sampling of my posts, you have seen that I spend a great deal of time and place much emphasis on exactly that issue . . and you know what? . . It is a big source of nasty comments regarding that suggestion. Seems that a lot of folks will not cotton to the notion that at least part of their problem was their passiveness and their inability or lack of nerve to confront their doctors and demand the service for which they are paying. Apparently you learned that lesson the hard way.
  5. Unregistered

    Unregistered Guest

    Oh, I'm quite cognizant of the fact that I should have stood up for myself (so to speak) long before I did. Normally I pride myself on being stoic and patient, but in this case, at some point stoicism and patience turned to passivity. I just accepted the "just use the crutches longer" push-off for far too long because ... well, she was the doctor and she had more expertise in this area, or so I thought. I had to get past that to where I was pretty sure she was just not doing her job. And what I think are generally good parts of my personality were working against me, and I realized that in certain circumstances, they aren't universally good.

    For me, the clincher came when I realized I was actually putting off making an appointment with her because I just didn't feel like it would do any good, that she wouldn't do anything substantial and wouldn't advocate effectively for my needs. She may be a medical expert, but I am the expert on my symptoms. Once that realization hit, I changed doctors and tackled the problem.

    I also realize that for doctors, I'm only one patient of many. I also realize that there are a lot of people out there who are what a friend of mine calls "self-diagnosing Internet crackpots" and it's my job to convince my doctor that I am not one of them. That said, there are good doctors out there, and there are bad doctors, and unfortunately my original PCP was one of the bad ones. I faced it, changed doctors, and have a good one now, and I wish I had done it months ago.

    In my case, the delay in my diagnosis was a shared fault. I take ownership of where I contributed to it, but I fired the doctor who was responsible for the other part. Lessons learned.

    Last edited: Jul 25, 2010
  6. Unregistered

    Unregistered Guest

    I suffered this injury 3 years ago. ER doc said it was just a sprain. Round two of xrays showed the Lisfranc injury. First surgery I had screws put into my foot - was not able to walk on the foot for months - was in a wheelchair. Second surgery the screws were removed and I was put right into the boot for another 3 months. Total time from initial injury to being able to walk in hi heels again was one year. It is a very long, very painful, very frustrating process. And just 3 weeks ago I fell again and my left foot is swollen - again I've been told it's just a sprain. Went for an MRI yesterday to be sure - I think lightning has struck twice and I'm not sure how I will handle it.

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