Lisfranc Ligament Rupture

[knighk18]

I'll try to make this as short as possible In February, I dropped a very heavy object on my foot, waited a week for it to feel better and ended up going to urgent care since the pain/swelling/bruising wasn't getting better. They took x-rays, told me I had a fracture, put me on crutches and told me to follow up with a foot specialist.

Went to the foot specialist, he took x-rays, told me I had 3 very small fractures, put me in a cam walker (boot), which I've had on since then. Been back to the foot specialist several times and the last time he took another x-ray and said something looked off around the Lisfranc joint. Sent me for an MRI, went back to foot specialist this week to review MRI, he tells me that the Lisfranc Ligament is completely ruptured...MRI report used the word "obliterated" so I'm guessing it's not going to grow back on it's own

Anyway, he basically said this injury typically happens in high-impact atheletes (which I am not), and he's only seen about 5 of them in his career, so he doesn't do the type of surgery needed to correct the problem. He's sending me to a surgeon next week, so fine, I'll see the surgeon and figure it out.

My question is, has anyone had this type of injury before? Anyone know what the surgery is and what the success rate is of this kind of surgery? Recovery time? Mobility after surgery? After effects, like pain, long-term and short-term, stiffness, range of motion, etc.? I've done about as much research as I can do and I'm just not finding much information in the way of a completely ruptured Lisfranc ligament...there's some info out there about a torn ligament, but it doesn't appear to be the same thing that's going on with me. I'm just looking for any information I can find, and specifically any questions that I should be asking the doctor when I see him. I'm just kind of at a loss right now. I'd appreciate any info anyone has!

I figured I'd add, in case I get asked later, that the pain that I'm having is pretty localized to an area about 2-3 inches in diameter on the top part of my foot, over the area where the Lisfranc joint is located. It does not hurt to walk, unless I go a day or so without the cam walker, but it's still quite painful to touch that area. It is a mix of red and purple discoloration over the area, burns and shoots pain when it's touched.

There MRI did say the bones apparently look fine in relation to that, but that there is some degeneration of some areas possibly due to osteoarthritic change...no idea what that means. I'm happy to quote the text of the MRI if it helps, but I don't want to be presumptuous.

Thanks!

Kira

[Heidi]

Hi Kira,

I'm afraid I don't know much about this injury, especially surgery-wise. I have found this article though...don't know if you have already seen it, but it has info on procedures and recovery times etc. Worth a look:

http://emedicine.medscape.com/article/1236228-treatment

I hope it helps and good luck!

[knighk18]

Thank you, Heidi!

That is helpful information...more helpful than anything I've found so far:) It's just strange that there is not more information out there relating specifically to a complete rupture of that ligament where the bones aren't necessarily involved. But that at least gives me a general idea of what's involved. I appreciate it!

Kira

[S & O]

Hi Kira

I hope this reaches you before your appointment with the surgeon :) I had a traumatic Lis Franc Injury 6 months ago and can totally symapathise with your frustration over the lack of information out there!! I don't have too many helpful hints I'm afraid as I've developed a complication called Complex Regional Pain Syndrom which apparently happens from time to time and know one knows (or can tell me) why.

In terms of surgery I had this 4 days after my injury(I was told that for the degree of Injury I had there wasn't a non sugical option advised) and they inserted 3 screws into the joint to stabalise it which I was told would be removed between 6 & 9 months post-op and that all going well they would know within 6 months what degree of foot function was likely to be gained but that it would never return to normal. I was non weight bearing in a rigid cast for 10 weeks then, put into a "moon boot" which is a rigid plastic boot which you can walk on as tolerated. Once I went into the boot I was allowed to take it off to swim (Which was great and really helped with the "head frustration" as well!!) But absolutely no weight on it when not in the boot.

I started physio to mobilise my ankle while still in the boot and once the boot came off I was allowed to cycle on a stationary bike. Luckily I have a really good physio who seems to know a bit about these injuries. But at the same time the message I have got from her and my surgeon is that there doesn't seem to be any "usual" progress for these injuries and everyone is different so it's a matter of being patient and seeing what happens. (not helpful I know but at least they're being honest)

My 4 pieces of advice:
1) Ask the surgeon if there are non surgical options for your degree of injury (Even if, as a surgeon, they are likely to say that's the best option, it just let's them know that you're gathering information and thinking it through)
2) Ask what their usual rehabilitaion plan involves as there seems to be a bit of a variance out there from the information I have been able to find.
2) Make sure you shop around for a physio who has some experience with these injuries cause you'll be spending a bit of time with them!
3) This is a really long and slow recovery (even if all goes to plan it seems like 6 - 12 months is the norm) so make sure you get some good people around you who can support you on the days when "frustration" gets the better of you :)

Hope this helps.

Cheers
Sarah

[knighk18]

Thank you, Sarah!

I actually have an update:

I saw the surgeon yesterday and I won't give all the details because frankly they just tick me off and most are irrelevant and consist of the guy just being a jerk. But the surgeon told me he did not "believe" the ligament was ruptured regardless of what the MRI said because in his experience, this injury also has some kind of fracture along with it. Of course he also didn't want to order a new MRI. I had to ask him to look at the MRI, ask him to read the MRI report and his response to my questions about what the verbiage on the MRI means was "this is why patients shouldn't have access to their medical records." He also told me that I do have arthritis in the joint directly under where the lisfranc ligament is supposed to be, but apparently doesn't believe that it A) is related to the ligament rupture, B) is causing me any kind of pain and C) is something new and i've probably had it forever and am using it as a reason to feel pain. Ugh, probably one of the worst experiences I've ever had. I'm not sure I've ever had a doctor tell me that he didn't "believe" the MRI. Maybe he was having a bad day:)

The point is, my original foot specialist told me the way to correct this injury was either a cast or surgery then a cast - the goal being complete immobilization. The surgeon's opinion is to do just the opposite - lose the cam walker, "suck it up" and start walking again...and apparently he'll send me to physical therapy if I think I need it, which is quite gracious of him given his lack of concern that I actually have an injury. It's just strange to me that one doctor says "don't move it at all" and the other says "take of the boot and go for a jog - you're fine."

I've scheduled an appointment for next week with a different foot specialist altogether, so perhaps he can break the tie. In the meantime, do I continue in the boot? Is the boot making it worse? I don't understand how two doctors who are practicing the same type of medicine can have such polar opposite opinions on how it should be treated. And to be clear, it isn't that I want to have surgery, nor would I love to have a cast put on my foot. However, I would like to feel confident that whatever course of treatment is decided on is the best solution, and to understand why and this surgeon really didn't have any reasoning behind the way he felt, unlike my original doctor who seemed pretty confident. I just kind of don't know what to do right now; perhaps the next surgeon will have answers, but in the mean time, I feel stuck.

Any advice would be appreciated.

Kira

[S & O]

Hi Kira

I'm SO sorry you had that experience and from reading your post can totally undedrstand that you're more than a bit annoyed!!

I think you're doing totally the right thing by asking for a second opinion :) I was lucky (or unlucky depending on your point of view!!) in that I had a 7.7mm seperation of the joint when I understand that > 2 on MRI is usually considered an issue. But like you I didn't have any broken bones (That they told me about anyway!)

In terms of "to boot or not to boot" Do whatever feel most comfortable is my advice. A week of being immobilised when it's not necessary is much easier to fix than a week of moving and doing more damage when you shouldn't (in my opinion anyway)

And can I suggest that you take a friend/family member with you to the next appointment? If you feel that you walked away without the answers you needed from the last time.......sometimes they ask the REALLY obvious questions that we forget to ask cause we think we've read enough or feel embaressed to ask etc........

And I know this may seem obvious but please don't pick what advice to follow on "bedside manner". At the end of day if the person is total prick but they know what they're doing then that's better than someone who is saying what you want to hear but doesn't have a clue! And the only way you can judge that is by "gut feel" or literature reference OR ask for allied health references!! (ie: get names of physio's and occupational therapists who they work with who can give you an idea as to "experience" of the Surgeon)

Fingers (and toes if they would move!) are crossed for you

Sarah