Return of the boot !

Ello, ello, ello,

Yes it's been a while hasn't it ?
I was so astonished to see that I'd had over 4000 hits when I logged on last night !
Thanks to all of you that have read my woeful tale :-) I have been quite miserable in some of the posts I've made ,I noticed, but then It's been a crap year for me ! A Lisfranc fracture is not funny & I'm not superstitious but I do find myself being careful around mirrors & ladders these days !
It has been probably the most difficult & challenging year of my life, not just because of the foot....
Where shall I start to bring you all up to date?
I think where I last left you will probably make the most sense....

Sadly I haven't been away pirouetting on the foredeck, or trekking up Mount Kilimanjaro :-(

When I returned from my road trip to the US last October, I learnt that my dear Grandfather Pete was seriously ill, so ill in fact he died just three weeks later. This event was devastating to me, more so than the consultation with Mr Ritchie last April when I learnt the full extent of the damage to my right foot.

We were best friends you see, really true best friends.
When together we were always in cahoots, giggling together about the silly daft things that our mutual sense of humours connected on, often hiding away together when I was a young child in his woodworking shed from my quite strict Gran when she was on the war path !
In fact I think my Grandfather gave me my love of the sea & all things salty ! As soon as I was old enough to walk he got me a life jacket & took me sea fishing with him off of the coast of Hastings in East Sussex. This was the way I would spend most of my summer holidays with him right up until the age of 13 or 14. My grandfather taught me all of the essential things that a young lady should know, like how to thread lugworm onto a fishing hook, how to cast a decent line, how to tell the difference between a Flatty & a Plaice (fish!) & of course how to tell a decent pint of beer from a wrong 'un', although not this lesson until I was of the legal age to consume alcohol of course :-)
I experienced my first man overboard with him on Emma 1 (of course it was me) & my first rescue by the RNLI when the new radio he'd installed on Emma 2 failed when we were out at sea. My grandfather found this event most exciting & whilst I was being uplifted from the boat by the RNLI, he got his camera out to photograph the entire proceedings- LOL

So it all came as a huge shock to me, to lose him so quickly & unexpectedly, the foot actually became second priority to my grief for the best part of six months. He'd appointed me as his executor in his will as my Gran had died 14 years previously. I carried out all of his wishes as best as I could & then after much soul searching I decided to leave my birth place- Tunbridge Wells for a fresh start. I found a house in Addlestone, Surrey, closer to my work, my son, the rest of my family & my man. Yes, my man did hang around (see earlier posts about my worry & self doubt) & he has proven himself to be my rock during this difficult period. I often wonder at his unwavering support & faith in me as he'd only known me for a few months before my life was turned upside down.
I moved to Addlestone on April the 4th, the house is lovely but a project. It needs extensive redecoration & repair as well as having a garden that needs designing from scratch. So I spent the first three weeks in April decorating & cleaning the house with my man in earnest & we travelled to London on April 22nd to watch a great friend of mine compete in the London marathon. The foot was behaving well, a little tender at the end of the day but that was about it. I discussed climbing Mt Snowdon with my friends that evening, I planned to join the local gym the following week & my man had just booked me a trip to Hawaii in October this year to celebrate my 40th birthday.

Then on April 27th after a few days of feeling a little more tender than usual I got out of bed & upon standing I experienced acute pain through my 2nd & 3rd toes. I presumed that I'd just overdone it, I took some Ibuprofen (Aadvil to all you Americans ) & continued with my day hoping for the best.  On the Monday evening (30th) I caved in & drove myself to the local hospital casualty department, by now walking was extremely difficult, I couldn't bend my big toe at all & the pain wasn't responding to the Ibuprofen. I had a standard X-Ray & it didn't show any fractures (neither did the one I had last September) but the doctor decided to refer me to the fracture clinic the following Friday as a precaution in view of my history. I declined the offer of Tramadol & decided to persevere with the Co Codamol & Ibuprofen that I had stocked up at home.
After driving some 700 miles for work over the next three days I arrived at the Fracture clinic sore & feeling slightly unwell. I met Mr Monk- an Orthopaedic & Trauma consultant who browsed my X-Rays with considerable interest & read the letters I'd taken with me that detailed the details of my original injuries, previous surgery & then the second fracture in September. He informed me that he was very experienced in Lisfranc injuries & expressed sympathy at my latest predicament. He recommended an MRI examination & a referral to his private clinic as the current waiting list for the NHS service was around six weeks. Luckily my health insurance provider approved this & it was arranged for the following Tuesday (8th May). Mr Monk also strapped my foot back into an Aircast boot & presented me with another pair of crutches, precautionary but essential as was the ban on driving he explained :-)
Oh the irony wasn't lost on my either, the date ? Well it was the 4th May, exactly 13 mths since my original injury..........
So I had the MRI & met with Mr Monk this evening for the results, the good news, no fractures detected, the not so good news was that the radiologist omitted my toes from the scan ! Mr Monk puzzled over my symptoms, he commented that I was a mystery as both he & the expert radiologist he'd asked to interpret & report on the MRI were convinced as was I that I'd developed a stress fracture in either my 2nd, 3rd or 4th metatarsal. A second MRI of the front of my foot has now been booked for next Monday (14th May) with a further follow up consultation booked for the 15th with Mr Monk.  Morton's Neuroma was also mentioned by Mr Monk as a possible diagnosis;

Morton's neuroma is a condition that affects the nerve between the toes. The nerve becomes irritated and compressed, which results in severe pain on the ball of the foot and at the base of the toes.
Morton's neuroma usually affects the nerve between the third and fourth toes. It is rare for more than one nerve or foot to be affected apparently.

So A further week of minimum weight bearing, in the Aircast & no driving awaits me now. I have limited Internet access at home due to no WiFi as yet so I re subscribed to SKY TV today just to relieve some of the boredom. I will have to sit on my hands to stop myself from getting up & grabbing a paintbrush or doing any more of the various DIY jobs that are outstanding in the house. I must admit I'm now doubting myself, I pondered on the way home if the pain really was that bad or was it just me being nervous about the foot ? When I got home I removed the boot & tried to walk around the house, yes the pain is still there, between my 1st & 2nd metatarsal, maybe not as acute as it was but enough to prevent me from walking normally. So I will just have to await the verdict on Tuesday.

I also received the results from my bone densitometry scan (DEXA) that my GP referred me for a month ago this week. It appears that I do have signs of Osteopaenia in my lower spine so it's a lifestyle change for me, from now on a careful diet & a lifetime's supply of Acal D3 (Prescription Strength Calcium & Vit D)! When my time comes to enter the Menopause then I will need a rescan & possibly more of the Alendronic Acid that I had following the fracture last September (Oh the joy !).

The positives; Well it's an Olympic year here in Blighty, Oh & we have the Queens Diamond Jubilee to look forward to ! Yay !!!!!!!!!!!!!

So I googled it !

Of course once home, I really needed to know more, in some ways it was reassuring that all of the pain I'd been feeling was for a good reason, but this new information had put a totally different spin on the situation it looked like I was in. So I googled & googled...................

Not all of the info available was pretty, nor was it easy reading, this Lisfranc joint has an important role in our mobility I was discovering. Some of the facts I discovered during my various searches, I've listed below. I decided that it was important for me to fully understand it, to then be able to accept the recovery period it looked like I was going to need.

• The Lisfranc fracture is a fracture of the foot in which one or all of the metatarsals are displaced from the tarsus.
• It is named after 18th- and 19th-century Napoleonic surgeon and gynecologist Jacques Lisfranc de St. Martin.
  Dr Jacques Lisfranc found a novel way of amputating the gangrenous soldiers feet between the mid foot and forefoot. They named the supportive ligament between the two bones in the foot after him, Lisfranc ligament. 
• This injury is usually seen in horse riders whose feet have been stuck in stirrups during a fall, or in people following a fall from height & sometimes in motorists who have been in an accident.
  This is an area of the foot is where you transverse arch is so it is typically very strong and rare to dislocate. 

• Apparently it accounts for 0.2% of all foot fractures.
• The lisfranc ligament is a ligament which connects the base of the medial cuneiform to the base of the 2nd metatarsal. It is injured or disrupted in the lisfranc fracture.
• There are two main forms of treatment, stabilisation & support using a cast followed by gradual mobilisation or surgery followed by immobilisation, & then stabilisation & support using a cast followed by gradual mobilisation

During surgery the location of the surgical incision is dictated by the location of the fracture and joints that are disrupted. If all five locations of the lisfranc joint are disrupted, then two incisions may need to be made on the top of the foot; one on the top inside and one on the top outside. If the first three tarsometatarsal joints are disrupted, then only one incision is made on the top inside aspect of the foot.

Once the disrupted tarsometatarsal joints are located, the dissection is carried down to the involved joints and the debris is cleaned out. The disrupted joints are then repositioned back to the position they were in prior to the injury.  The joints are then fixed with strong screws.  However, if the fragmentation is excessive, a plate may be required. One exception is a disruption of the 4th and 5th tarsometatarsal joints; in this case, the bone is provisionally fixed with wires.  The wires are then removed after about six weeks so that some movement of these joints can be encouraged.

A typical post surgery recovery timeline might be as follows;

• 0-6 (or 8) weeks Post-Surgery.

The patient is non-weight bearing to allow for adequate healing. Not only do the bones need adequate healing, but the disrupted ligaments as well.  The ligaments actually require a longer time to heal.

• 6 (or 8) – 10 (or 14) weeks Post-Surgery.

The patient can being weight bear as tolerated provided the foot is protected in a walking boot, such as a CAM walker.  This boot (characterized by a rigid sole and a rocker-bottom contour) serves to disperse the force away from the middle of the foot and up the leg.

• 10 (or 14) + Post-Surgery.

At the 10-14 week mark, the patient can then transition into a stiff soled shoe.

A displaced injury takes a number of months to recover.  For most Lisfranc injuries about 70% of the recovery occurs in the first 6 months, but it is often a year or more before a patient has reached their point of maximal improvement following a significant Lisfranc injury.

Websites I used & have quoted from here are : www.footeducation.com & Wikepedia.