Wednesday, March 7, 2018

Lisfranc fracture dislocation

Prior to Jan 8th of 2018 I had never even heard of a lisfranc.........
My story begins on December 23rd 2017, I was moving a mattress from one room to another and got it stuck between two rooms, I thought no big deal I will just climb over the box springs and go around and shove it in. (So I thought).... as I was stepping down from the box springs with my left foot I twisted it and tried to catch myself with my right foot. That didn't turn out too well I twisted it too but so much worse than the left. I crawled to the living room or rather drug myself there after I woke up in the floor as I'm sure I passed out for a minute. I got my phone and messaged my husband who took me straight to the er. The er x-rayed my foot and said just a sprain and put me in a boot and gave me a referral. Since it was December 23rd, almost Christmas no one could see me. December 26th I went to a different hospital and again was xrayed and again told it's just a sprain as well as given another referral to a specialist. Again it's around the holidays and No one would see me. On Jan 4th I returned to the er I went to first because it had took on a red tint and was very hot to the touch. The er x-rayed again and tested for blood clots, No clots and again told it was just a sprain. Fast foward to Jan 8th I finally got into a specialist who believed it to be a lisfranc fracture but requested an mri to confirm. The mri was done on Jan 11th and that evening the doctor called and requested no weight bearing and stated it was a severe injury... a lisfranc fracture with dislocation of the first and second metatarsal. I returned to his office within that week and he wanted to do a wait and see approach stated it did not need surgery just remain non-weight bearing for 6 weeks, at my appointment on the 7th week my right foot was still swollen, red and had numbness. The doctor stated he now believed I had complex regional pain syndrome and that is why the foot is not healing on its own and referred me to a neurologist. I used my better judgment this time and called another specialist who luckily was able to see me the very next day which was March 1st 2018. The new doctor said that it is dislocated 2.9 mm and that will not heal on its own it needs and has needed surgery. So Monday 3/5/2018 I had the orif surgery (open reduction internal fixation ) with arthrex tight rope. Let me tell you it hurts so very bad. Im in a constant state of pain. The key is to stay on top of the medicine which I have been trying very hard to do. I'm going to include pictures of what to look for when trying to diagnose this type of injury and will update along the way.... please feel free to share your stories of recovery. Note the bruising on the bottom of the foot , almost always a lisfranc injury. I also learned that the dislocation was pressing on a nerve and may have caused permanent damage due to not treated timely.

I'm now 3 weeks post surgery about 13 weeks since the injury that will become one of the worst things in my past. I had a problem with an allergy to not only the mesh they used but the steri strips that were put in place at post op 2 week follow up and the dermabond glue as well. Currently taking a steroid dose pack and using hydrocortisone cream on the rash. Surgery was horrible and the night stay in the hospital wasn't much better , couldn't have had surgery at much worse of a time than when the country is short on pain meds. To say it was hell is an understatement. I was released on gabapentin and percocet for home which I have almost completely stopped taking, I'm starting to get those dreaded nerve pains as my foot is waking up. When it doesn't hurt it's numb. I'm not sure which is worse. I believe I currently have 3 more weeks before I can begin partial weight-bearing with a boot and then 2 weeks later physical therapy begins. Learning to walk again after 5 months. Today the swelling is down alot, and most of the rash has began to dissappear. 

Today makes 5 weeks and 3 days since surgery and I have actually had a few restful nights sleep. Last night I bumped the fourth toe on my knee Walker so I'm paying for that today , in the way of pain and swelling. Looking more like a foot every day though and next Thursday I start physical therapy. I can't hardly wait. I'm nervous and scared but excited too.
So today Marks 2 days shy of 17 weeks since I took a step on this foot and today was my first day of physical therapy. The physical therapist said in my case it was good I hadn't been able to wear the boot this whole time because my range of motion is good for someone who has been out of commission so long. We did a tennis ball under my foot and I rolled it around with pressure applied as I could tolerate, he also said I could use a frozen water bottle 1 time a day. We did some ankle rolls left and right as well as ice therapy. Let me tell you that wasn't as great as I had hoped it would be. 10 minutes spent icing and my foot felt like it was going to break right off because it was so cold. Today I also took my first 10 to 15 steps with the boot on of course and a walker. Mentally it was great. Physically it was very painful. I didn't put my full weight on it as I stepped. More mental I suppose as I am so scared I will reinjure it. Starting next week I will do physical therapy 2 times a week for a while . The road to recovery is in site. Seems a little more swollen after therapy however.
Today was my 6 week follow up appointment post surgery. The doctor said it looks good which is surprising since I had physical therapy today too. The doctor told me those sweet words I have been wanting to hear for 17 long weeks. You may now walk. Get rid of the boot and go to tennis shoes also no longer use the knee walker. However he did say dont do it if it hurts. Listen to your foot. So I made it to work and took a walk around the halls and back to my office. Worn out when I got back so maybe stick with knee walker this afternoon.
Today I also moved my toes for the first time in awhile. I still have numbness but the doctor said that is going to take a long time to go away. So I'm not there yet but I'm getting there.
Here i am week 10 been going to therapy twice a week.
Physical therapy today..... so we didnt do a whole lot of hard labor intensive stuff. Rode the bike for 10 min. Did a few stretches and he could see that my right ankle still doesnt have the dorsial flexion it should. He says he believes it to be two things, one there is a bone that runs down the calf and sometimes after an injury gets sort of locked in place so he attempted to get it to pop stubborn thing just wouldnt do it. Also the calf muscle is entirely too tight so the next thing we did was something like acupunture except the needles latched onto the muscle thatruns down my leg trigger point dry needling i believe its called. From there he put electrodes on it to try and loosen the muscle. Felt weird had my foot jumping. Doesnt feel any better after but he said may take a few times. As for now I was told to stay on two crutches.
I haven't posted in a while and today I am 3 months post op. I put the crutches down and am currently walking without them but still have a limp and a pain level of about 3. Still dealing with daily swelling and problems finding a comfortable shoe. However any progress is better than no progress so i will take it.

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