Physiotherapy, shoes & all that follows Lisfranc Surgery

2 1/2 wks post op removal of compression plates, fixing screws & arthroscopy.

I saw my surgeon last night for my post op check & all things considered I didn't think the foot looked too bad .............. I now have one more incision, on the inside of my foot following the arthroscopy but he used the same scar for the metalwork removal & I have to say, I think he did a better job of closing it this time then after the original surgery. What was encouraging was the lack of significant swelling, this is a positive sign apparently & is as a result of all of the elevating & rest it has been given. So there we are, the Lisfranc mantra of "keep your foot up" obviously works !
I still have internal stitches which will dissolve in time, but I can go back to bathing with "my foot"- heaven ! I looked down after the dressings were removed & thought there were a couple of blonde hairs that were perhaps stuck to the sticky residue left behind, but after a gentle tug & a bit more scrutiny, I discovered that they were in fact attached ! They were the 'tails' for the internal stitches- LOL
I will start with an intensive moisturising regime & will buy some "Bio Oil" to rub into the scar. My surgeon says that this stuff really helps with scar healing.......... time will tell !


I explained how I'd tried to build up the weight bearing last week & the amount of pain that I experienced afterwards.............. After an examination, there was some tenderness around the 3rd & 4th metatarsals. My surgeon commented that it is possible the bones haven't fully fused yet, which would explain the discomfort. He was hoping that I would start full weight bearing in a shoe yesterday, but in view of the pain etc, he has asked me to continue with trying to build up the weight bearing whilst wearing the (now stinking !) boot & I will see him again in two weeks time for another examination & X ray. But the good news was I am now ready to meet with the physio terrorists as I fondly call them & they can now be let loose on "the foot".
I must say, my ankle & foot are so painful & stiff at the moment it is hard for me to believe that I will manage to walk in a shoe in a couple of weeks time, but I'm hopeful that along with targeted physiotherapy exercises & a focused effort from me, it can happen. I'm sitting at the moment on my sofa with my laptop on my knees & both feet flat on the floor. Not really weight bearing, but bending the ankle joint & flattening the foot on the floor. My ankle joint has been in a rather odd position pretty much since I had my accident & although I do try to bend the joint & rotate it from time to time, it still will not reach the 90 degree angle which is normal.The pain has been gradually building whilst I've been writing this post & I know I will have to elevate it again shortly.
It's all very well, but when does this need stop ? Does anyone know if this need to elevate gradually lessens & "the foot" will build up enough strength to become strong enough not to need it so often ? I'd be grateful for an indication of how long from where I am now this will begin to happen too.

I have been thinking that swimming would be a good thing to do, but there are no facilities close enough to me to be able to get to without a lift or taxi. Maybe I might just have to stomach the bills & overcome the diminished self confidence & just go ! Quite frankly I think I'd do anything at the moment to help reduce the pain & accelerate the recovery process if I could.

Removal of my compression plates & screws Day 103

On July 15th I was re admitted to hospital for the removal of one of the compression plates & five of the screws that were holding this plate in place & supporting the Lisfranc ligament.

I arrived at 12.30pm, in my boyfriends Porsche, with the roof down of course! Peter Gabriel's Solsbury Hill was blasting out from the stereo, the sun was shining beautifully & well, arriving in style seemed like fun. A sort of ironic celebration I guess, but either way it took my mind off of the surgery for a while & I arrived at the hospital in good spirits.
I met with my surgeon who talked me through the process, it didn't seem to be complicated, but I was advised to have another sciatic nerve block from the knee down in addition to the GA. This was instead of Morphine, which the anaesthetist thought I may need in post op recovery otherwise. So the waiting began................

After a few hours of flicking through the daytime TV, fiddling with my Ipad, photographing the foot pre op & planning a possible holiday in October my boyfriend & I were pretty fed up with waiting & were beginning to wonder if I'd be able to go home after the op as I'd wanted to.

Eventually, just before 6pm, the porters came & got me !
Although I was a little anxious, with sweaty palms, i was relieved to finally go. Everyone was really friendly, I cracked a few jokes about needing a glass of Merlot & celebrating the end of "the foot" which now felt like it's not too far away. My lovely anesthetist gave me a little something via my canula to make me feel fantastic (I have no idea what it was, but it worked!) I'd agreed to have the nerve block administered while I was conscious, so I was asked to roll over onto my belly, I watched them do it over my shoulder. My sciatic nerve looked like a ball of wool really, a white mass on the ultrasound screen, to numb it, they injected anaesthetic around the outside edge of it, through the back of my knee, at equal distances, like the 12, 3, 6 & 9 points on a clock face. After rolling back onto my back, I can't remember much more really, the GA was given but I think i may have drifted off before then...........

So what actually happened to "the foot" whilst I was under was, my surgeon removed the plate which was bridging my 1st cuneiform & 2nd metatarsal articulation & also the 2nd metatarsal joint. he discovered that these joints were stiff & some of my tendons had become attached to the plate. So he also carried out a formal arthroscopy (examination & flushing out/cleaning of the joint to re mobilise it) & then an open release of the extensor contracture ( releasing the large tendons from the surface of the plate by laser). It all went smoothly apparently & I had a 'smooth uneventful flight' according to my anaesthetist.

I woke up at about 8.30 in recovery, feeling pretty groggy but already relieved & happy. After some oxygen, I was taken back to my room, where lovely boyfriend was waiting with a gorgeous smile for me :)
I peered under the duvet, to see "the foot" well wrapped, looking almost ball like in shape, with the familiar Iodine staining on my toes & around my ankle.

So the deal was, I had to eat, pee & walk convincingly on my crutches in order to gain my release from the hospital that night by the "physioterrorists" ! After half an hour or so, I began to munch the sandwich proffered to me & drink the tea in earnest, so as to satisfy the release criteria- ha ha !
We tried at 9.30 pm, then again at 10.00pm, I was given one last attempt at 10.30pm.

I could feel nothing in the foot at all, it just flopped about, & my head felt strangely separate from my body, but after forcing the foot back into the aircast boot & a few deep breaths, Voila ! I achieved the necessary few steps around the room on the crutches & the tea had performed it's magic too. Home I went, much more appealing to sleep it all off in my own bed than stay another night in hospital. I took Co codamol & Diclofenac home, just in case.

Saturday night, I was determined to take out BF for dinner, to say thank you for all of his support & to celebrate ! So we did, I managed to put on a high heel (hitched my crutches up a notch) & a dress & off we went. It was lovely, Chinese with a bottle of bubbly, foot still numb & although I was still a bit tired it was worth it.
So the nerve block worked fantastically, it finally wore off about 3 am on the Sunday, over 30 hours after the op, I'd recommend having one to anyone, much nicer than the groggy mess that Morphine can you leave you in sometimes.

But on Sunday I paid for not obeying my body, I was sooo tired, sore & groggy I slept most of the day. I took the Diclofenac & a couple of doses of Co codamol to take the edge off. Monday was spent dozing on the sofa too.

It's now 4 days since the op & I don't feel too bad. the foot is still a bit sore, but that's too be expected, but the swelling isn't too bad & the pain is bearable. I've been told to try to start fully weight bearing in the boot over the next 2-3 weeks, building it up gradually, but stopping if "the foot" protests too much.
I'm back to see my surgeon on the 2nd August........