mild lisfranc/midfoot sprain-any feedback?

[Water]

Short fall (2-4ft) wearing rock shoes. Landed funny on foot. Immediately (Pain-7) thought something was wrong, got xrays a few hours later (negative)--immediate care doc said plantar faciitis (ha, ha...ha, not funny or accurate) Redness/Miniscule swelling during first 12 hours then looked normal. Pain at 4. No bruising. followed RICE. Compensatory walking, weight kept to outside and heel. No pain when stationary. Walking is more like discomfort level--2.

 

Waited 11 days then went back to see doc (PA). Was referred to PT but I questioned concerns going to PT to treat symptoms vs treatment plan for a diagnosis. They consulted with sports med doc about this, came back suggestion is walking boot for a few weeks.

 

Anyone have any experience with the Lisfranc joint? sounds like if you have, its not happy.. one of the many things on the continuum of not fun! some better..some worse.

 

 

 

[Water]

bump. didnt resolve after 4 weeks of diligently wearing walking boot, but did improve. Pain only in odd situations (side to side compression of foot/pushing down on outer 4 toes while lifting foot up...and that foot/ankle being weak from wearing a boot for a month. 1st sports med doc dx hairline fracture of second metatarsal--but was just guessing on xrays, and wholly discounted possibility of anything to do with lisfranc.

 

saw a specialist this week and they immediately honed in to lisfranc. appears to be a subtle injury if so.

 

anyone been there/done that with this injury [midfoot sprain/lisfranc damage] (to any degree?)

[Water]

Well I will write more on this...

 

first of all this experience has taught me not to expect medical system to be the advocate for your health. You must trust your gut and be your own champion to make sure your issues are addressed to your own satisfaction. There may be good and bad doctors but i'd rather think of it as right and wrong doctors for an individual. Nobody I saw had bad intentions, but, the right doctor resonates with the patient and has the expertise to reflect back that they understand what is going on and present a firm basis of diagnosis and options.

 

Secondly this injury is very very easily misdiagnosed (as I was twice) and can go undiagnosed if original dx do not hold up. So it often gets overlooked. It occurs 1 out of 55,000 in the general population but there still appears to be a ton of info about it. It is the second most common NFL foot injury behind turf-toe.

 

My hunch/self-diagnosis from almost 2 months ago was spot on. While that may seem smug I sure as hell wish I had been wrong. Even though I wasn't in much pain, my foot felt weird and I certainly wasn't jogging on it or climbing. MRI results were quite clear of at least a partial if not complete Lisfranc ligament tear, and signs of damage to the plantar surface Lisfranc ligaments that go from the medial cuneiform to the 2nd and 3rd metatarsals. General soft tissue edema around the head of the 2nd meta and possible a small avulsion (bone fleck) which is highly indicative of a ligament tearing off. Also marrow edema (bone bruise) on the medial plantar surface of the medial cuneiform where the Lisfranc ligament connects to it. I was shocked that the edema was visible still 8 weeks after the injury to be honest.

 

Got those MRI results Tuesday Feb 18th and had surgery on the 21st. Instead of drilling a screw between the medial cuneiform and the second metatarsal I opted for a somewhat ingenious but more expensive method that runs a wire-like suture between the two instead. A hole is still drilled through the bone, but it is smaller diameter (2mm vs 4mm for screw which has threads that go to 5mm) and then a shirt like oval button is put on one end of the hole with the suture material wrapped around through it. On the other end a 'cap' button is used. This has a small cylindrical base which goes into the drill hole and then has a smooth head which has a tiny hole in it for the wire suture to come out of. Think of the fly rivet/button on jeans. Thus the suture is pulled tight and tied off with the joint and bones in proper alignment. It is not a bionic ligament--but it is quite strong. Like the screw the important part is keeping the area in tight alignment like it normally was. The real healing/recovery comes from not bearing weight on it for 2-3 months, as the Lisfranc joint is an up-and-down movement in your foot (dorsal to plantar).

 

The main benefit is that this does not require a second surgery to remove with the risks that come with surgery. Also there is not a strong consensus on when to remove screws and to allow them to bear any weight, so it bypasses those variables. There is no consensus due to the wide variety of simple and complex foot injuries and each doctor tends to have their own view. Also depends on the patient of course (age, athletic, non-ambulatory, etc) Generally recovery has been faster with this method due to no second surgery but also because unlike screws the wire does allow the joint to move, weight bearing can begin sooner. My doctor said this was the method he had been using on athletes. I would have to believe having less bone material drilled out of the foot is also inherently better.

 

Downsides are that it is a newer technology (maybe 8 years? I need to research when it was made available by the FDA? not just in trials). It costs a lot more. Stainless surgical screws are ~$50 and this tight-rope method by the Anthrex company is ~$500 (probably $2000+ on the bill I'll get). There have been some reports that the wire has laxity--ie if ti was not tied tightly (really can be mitigated easily) and that over time it could loosen, however the time scales seemed much longer than the 8-12 weeks in which it is thought that the ligament heals, so that is not considered an appreciable problem.

 

General recovery from this injury is 6 months to 1 year. At 24 months one should have an accurate view of what their foot health should be like going onward, assuming there haven't been complications from surgery or recovery. Timelines can certainly be adjusted up or down depending on the wide amount of healing and patient variables--good ol' luck of the draw, to be exact.

 

Iong term prognosis from Lisfranc injuries generally are not good. There are better ways to hurt the foot for sure. At a minimum arthritis is very likely, in many cases almost a guarantee. Joint fusions are sometimes done in the first place to treat this, and are used when this injury has gone untreated or misdiagnosed for too long (months-years). If initial surgeries are not successful then fusion is what is done. If arthritis gets to be debilitating, fusions are done (patient option in all cases of course).

 

That said, people do recover full from this injury. Just like cancer and broken backs and comas and all sorts of things that are SO much worse than a foot injury!

 

My injury was a grade II sprain. The joint had normal alignment at rest. If it did not it would be grade III. That is generally better for long term prognosis. So I'll take that. A custom orthotic will be needed of course. I have no idea if this will have any bearing on my situation, but as the Lisfranc joint is somewhat a keystone or linch pin of the arch, I'm curious if my naturally pretty damn flat feet will have any impact on recovery and long term results. Being flat maybe that joint does not get loaded as much as i hold weight on most of foot vs being high arched the weight is carried on the fore and rear foot.

 

I'm doing a blog for this and will post a link to it later but figured I'd at least wrap this up because the whole of cc.com doesn't have a single report of anyone doing more than briefly mentioning this joint 1 time.'

 

cheers

 

 

[Water]

well none of you lucky bastards has had this injury or heard of it except someone who responded to a pm who mentioned Lisfranc in a post 10 years ago. For any poor soul who gets this injury down the road and goes hunting on CC for info, feel free to pm me even if it's years from now.

 

Injury blog:

http://lisfranconsciousness.wordpress.com

[astrov]

Water, good to see you last night and keep fighting the good fight. we'll have the hills ready for your triumphant return.

Edited March 23, 2014 by astrov