# Lisfranc foot fracture



## FM (Apr 30, 2003)

I'm writing this just in case somebody in the future might use the handy 'ole search function to learn more about this injury.
 
*
background:*
About 9 weeks ago I jumped/fell 7' down off a ladder bridge and landed on my feet. Upon landing, it felt like a bad sprain in my right foot but then I felt something pop 2-3 steps later. Something was not right- I was able to coast out, but I couldn't really walk or pedal. Thankgod I was able to get back to the car easily by coasting down on a paved road. I skipped the ER and waited until monday to get it checked out (I was not in severe pain, but also not able to walk during this time.)

*Hospital Prognosis:*
At the hospital I was directed to the sports medicine clinic where a podiatrist ordered x-rays and CT scans of my right foot. These showed 6 different factures- the larger 4 metatarsels at the upper joints (minimal separation), a 3mm separation fracture in the middle of the 4th metatarsal, and a 2mm wide fracture along the interior edge of my medial cuneiform joint. This one was the most troubling to the podiatrist. Based on all this he recommended surgery (not by him) as soon as the swelling went down enough. I did not know at this time the surgery would have involved fusing the lisfranc joints.

I have a relative who is a physical therapist, he strongly urged that I get a second opinion from an orthopedic surgeon who specializes in foot & ankle reconstruction. He said basically a orthopedic surgeon generalist at a big hospital might only due this surgery 1-2x a year, and the outcome is often not so great.

*Second Opinion:*
I had to wait nearly a week to see the orthopedic surgeon who specializes in foot & ankle reconstruction. I brought my films, but he had a new "weight bearing" set of images taken. Based off these, he was very confident I could heal without surgery. He had me spend 5 weeks total in hardcasts (3+2 in 2 casts) and then another 3 weeks minimum in a boot, all this time non-weight bearing. I saw him 4 times over this 8 week period and recieved x-rays each time to check the progress.

So now, after 9 weeks total, I am off the crutches and beginning to put weight on the foot. Still in the boot but X-rays show everything's healed correctly so I expect to make a full recovery and gradually get back to being active over the next 6 weeks. I will also be getting orthotics.

I am pretty stoked to be near the end of this and walking again! 

There are all kinds of Lisfranc injuries so there is no treatment that works for everyone. I was very lucky to not have dislocation and that I got the second opinion. The main thing I would reccomend to anybody else who has this injury, is what my relative suggested: that I *get a second opinion from an orthopedic surgeon who specializes in foot & ankle reconstruction. * Also don't underestimate this injury, the research I did was not encouraging- many people who rush their recovery never heal.

Hopefully nobody needs this info, but maybe it will be helpful just in case.


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## toowacky (May 24, 2005)

*Lisfranc fracture/dislocation*

Hey FM,

Glad to hear that you're getting all healed up, sounds like you dodged the bullet w/o having a dislocation. In 2002, I had a pretty bad Lisfranc fx/dislocation of my right foot, per a motorcycle accident. Wasn't so lucky, had surgery and 3 screws to fixate the metatarsal/cuniform joints, then another to remove them after they "healed".

I bought my first full-suspension bike after that. Still feel the pain every morning when I get up and take those few steps, but a small price to pay to be able to move around as well I do. Way back before modern medicine, a fx/dislocation typically meant amputation, like during the Civil War.

And to think we both like hardtails, still 

Good luck!


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## FM (Apr 30, 2003)

toowacky said:


> Hey FM, In 2002, I had a pretty bad Lisfranc fx/dislocation of my right foot, per a motorcycle accident.
> Good luck!


Hey toowacky- Crazy, what a small world!

Yeah I think I was pretty lucky- I mean it's not a great injury for anyone to have, but my circumstances have been pretty ideal- no dislocation, minimal gaps in the fractures, a relative who gave me great advice, and maybe the biggest one was that my insurance allowed me to "self-refer" to the specialist my relative recomended as his first choice.

I'll actually be having my relative (bro-in-law) do the orthotics and any PT- also covered by my insurance.

question for you- do you ride flats or clipped, do you find the stiffer shoes make a big difference? I was riding flats only last year, even for XC, but I'm wondering if I should switch back to SPD's when I start riding again, so I can run stiff shoes with orthotics.

I bet your diggin the alpine! I think the burly hardtail will be ideal for the riding I'll do next year- less FR/DH and more trails- just riding again!


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## ebxtreme (Jan 6, 2004)

That's GREAT news, FM! Can't wait to have ya back out on the trails again.

Thanks for hosting CBX last week. She had a total blast hanging with the fam!

EB


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## Fibula (Oct 20, 2008)

Just because you healed without surgery doesn't mean the ortho or the PT was right. If you saw another ortho he might have agreed with the podiatrist. Also, if the podiatrist that did the scans was going to send you to someone else, obviously she or he isn't surgically trained and the subsequent podiatrist may have said you don't need surgery.

I've seen many instances of post-traumatic arthritis in people with lis francs injuries that were missed or not operated on immediately to realign the joints. These injuries, even if operated on, are bad. You will probably need a lis franc fusion sometime in the future. 

Orthotics from a PT? Good luck, man!


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## toowacky (May 24, 2005)

FM said:


> Question for you- do you ride flats or clipped, do you find the stiffer shoes make a big difference? I was riding flats only last year, even for XC, but I'm wondering if I should switch back to SPD's when I start riding again, so I can run stiff shoes with orthotics.


Both flats and clipped. Flats came stock on a bike I purchased in 05, and just got some 5.10's this summer. Last summer I was riding SPD's on a teeter to skinny on the exit, and while back behind the seat, the right shoe unclipped, I separated from the bike, and ended up sliding into a log, acquiring a medial malleolus fx (think inside ankle bone). Trip back to the same ortho, 2 screws and a few months later, I was good to go. The current plan is that more FR and skinny terrain, or muddy DH, I wear flats (the 5.10's stick so well it's hard to tell the difference). On XC and fast dry I run the SPD's, with mid-level Shimano shoes and a Sole orthotic. I really don't notice much of a difference as far as comfort, the 5.10's fit really well-- haven't been tempted to move the orthotic over to the 5.10's yet, as they have decent support.

A couple of observations... Although with the last fx I now have two screws permanent, it was definitely the lesser of the two injuries. My lisfranc legacy still bugs me every AM when I step out of bed, but just for the first few steps. I wear some sort of orthotics in most of my shoes now. The lisfranc encounter that I had was a pretty brutal fx with the engine case of the moto coming down on my heel, pushing the front of my foot to the pavement. Lots of bone fragments needed to be cleaned out. Ortho advised that I may have arthritic pain, and if it got too bad, a fusion would be the solution. So far, I just deal with it... however, echoing the previous poster, if you have any doubts, another review of the injury might be a good idea.

As far as the Alpine, it's a winter project, not riding it yet. Building wheels and assembling parts for the build-up.

Take it easy. T


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## FM (Apr 30, 2003)

toowacky said:


> Both flats and clipped. I really don't notice much of a difference as far as comfort, the 5.10's fit really well-- haven't been tempted to move the orthotic over to the 5.10's yet, as they have decent support.
> 
> A couple of observations... My lisfranc legacy still bugs me every AM when I step out of bed, but just for the first few steps. I wear some sort of orthotics in most of my shoes now.
> Take it easy. T


Thanks for the info TW. Wow two injuries to the same foot, you've had some hard knocks. Glad you're riding techy stuff though, that gives me hope I may be able to do some FR stuff again. Although I'm getting less interested in "going big" with every injury I witness- not just my own.

Quick update, I've been off the crutches for about 3 weeks now. The foot feels just a tiny bit better each day, and each week I'm making good progress with returning to mobility.

I got out and did a 23mile flat road ride sunday. Seated pedaling feels A-OK  
I can't really pedal well out of the saddle yet, so I'll take it easy for a week or two then try again.



Fibula said:


> Just because you healed without surgery doesn't mean the ortho or the PT was right. If you saw another ortho he might have agreed with the podiatrist. Also, if the podiatrist that did the scans was going to send you to someone else, obviously she or he isn't surgically trained and the subsequent podiatrist may have said you don't need surgery.
> 
> I've seen many instances of post-traumatic arthritis in people with lis francs injuries that were missed or not operated on immediately to realign the joints. These injuries, even if operated on, are bad. You will probably need a lis franc fusion sometime in the future.
> 
> Orthotics from a PT? Good luck, man!


I'm not quite sure what you're getting at?
I'm lucky in that both my family, my wife, and my wife's family are in the medical industry. By bro-in-law (PT) suggested two orthopedic surgeons who specialize in foot & ankle surgery, who he knew personally. Turns out my one of my sisters and her husband had worked with the same two surgeons. Pretty solid referrals in my book. My bro-in-laws' rec' was based on the outcome of patients he's treated- he said the patients that had seen either of these to docs typically did much better than those who had surgery by a generalist. But interestingly, of the two docs, one has a more aggressive style and prefers surgery, where the one that I saw is more conservative. Either way, I have nothing to lose by healing w/o surgery. The outcome of surgery in 6 months or 6 years would be no different than if I had had it done immediately according to my rX. The option is always there, but I'd like to avoid it if possible. So far, so good!


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## ruler (Jan 15, 2009)

toowacky said:


> Hey FM,
> 
> Glad to hear that you're getting all healed up, sounds like you dodged the bullet w/o having a dislocation. In 2002, I had a pretty bad Lisfranc fx/dislocation of my right foot, per a motorcycle accident. Wasn't so lucky, had surgery and 3 screws to fixate the metatarsal/cuniform joints, then another to remove them after they "healed".
> 
> ...


Hey toowacky, just came across your post. I had basically the same injury that you had a little earlier this past summer. Though I also decided to shatter my ankle along with the liz franc injury. I have 2 screws in my foot to stabilize the liz franc and had 2 pins in there too. The doc said the other fractures would heal on their own because I was casted and non weight bearing for 2+ months. I also had 9 screws and 2 plates in my ankle but that is another story. I am almost 6 months out of surgery, got it done in Philly by the best ortho in the area for foot and ankle injuries. I was wondering what to expect going forward? I am supposed to get the screws in my foot out next month. I hope this relieves some of the stress/ stiffness I feel in my foot. As you stated, getting out of bed in the morning really stinks. I have what feels like a lot of tightness in my foot that usually works itself out by mid morning but by the end of the day my foot is very sore. It feels like I need to crack it? My ankle on the other hand is healing very nicely. It sounds like I am going to experience this pain forever? I was wondering if you have any advice/ stretches that have helped you out. I started trail riding again a few weeks ago and everything is going ok. I am no longer using clipless for riding trails, got myself a pair of 5 10' casuals that I can fit my ankle brace into. I am happy to be riding again but I had been a downhiller/ dj'er that liked to go big and I really want to get back to that. Right now I just don't feel the strength in my foot to allow for that. Do you have any thoughts on how long the strength takes to come back? The docs said that it would take at least a year to feel decent.

Thanks

RH


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## spongstick (Feb 6, 2004)

Fibula said:


> Just because you healed without surgery doesn't mean the ortho or the PT was right. If you saw another ortho he might have agreed with the podiatrist. Also, if the podiatrist that did the scans was going to send you to someone else, obviously she or he isn't surgically trained and the subsequent podiatrist may have said you don't need surgery.
> 
> I've seen many instances of post-traumatic arthritis in people with lis francs injuries that were missed or not operated on immediately to realign the joints. These injuries, even if operated on, are bad. You will probably need a lis franc fusion sometime in the future.
> 
> Orthotics from a PT? Good luck, man!


Are you a Ortho.Doc or a Podiatrist?


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