Day 80 Weight bearing- Woohoo !!

I had a really good appointment at the hospital today, for the first time in this recovery process, I finally received some real positive news !
My AP & Lateral X rays looked as good as the consultant would expect at this stage, his words were "You're making a good process in line with what I would expect at this stage".  The fusion (with bone graft) of the 3rd TMT joint is healing well & the plate & screws that are also holding it & the 4th metatarsal will remain permanently in my foot. The 2nd metatarsal which was treated with an open reduction & fixation look like it's healing well, the screw that was put in in place will hopefully be removed along with the fixation plates & screws in the 1st metatarsal. If I continue to make progress at the same rate, I can expect this to happen in about 17 days (July 15th).
After examination of the foot, he was encouraged with the low level of swelling that it presented with.  He wasn't concerned by the swelling I described & the purple appearance "the foot" sometimes adopts he said it was quite normal to experience this after exertion at this stage & I should take it as a sign that I need to rest it whenever it happens. The swelling should always subside after resting, which mostly it does.
I explained to him the problems that I was having with the boot, it was loose & hung awkwardly on my foot rather than supporting or cushioning it. This was causing the bridge of my mid foot to become sore, pins & needles in my toes & irritation of the operation scar.  He explained that he was hoping to get me to start weight bearing using the boot, so we needed to resolve this other wise it would mean transferring back to a cast, which would be a slight regression. So we hopped along to the physiotherapists office to see what her verdict was. After having a look, she explained that the boot was far to loose, following the reduction in swelling over the past 3 weeks. I also still cannot get my ankle & heel to bend into the normal 90 degree position due to stiffness & swelling within the ankle joint. This is also affecting the positioning of my foot within the boot. The physio suggested that we try to inflate the air cushions more to hold my foot in a better position, although it would mean discomfort short term, the long term benefits would be important. After doing this, the boot was a lot tighter, all around my foot & calf, apparently this is how it should have been all along :( I also need to continue with the ankle exercises at home.
Then came the "moment"................. after another nurse was called in for support, I was asked to stand up slowly.............. on both feet ! After much coaching from the physio & lots of instructions I then began to walk, just putting 50% of my weight into my heel. Crikey it felt alien, completely abnormal ! I painstakingly slowly put my crutches out in front of me, then brought my bad foot through, parallel with my crutches, put my weight down into it's heel & then brought my good foot through to meet it. The smile on my face after the first couple of steps was immense ! I even felt emotional, my bottom lip wobbled a bit, I don't mind admitting. The relief was over whelming, at last a real tangible step forward in my recovery process. I also had a lesson in staircase techniques, so hopefully after a bit more practice, I may be able to leave the days of bum shuffling behind me- Yay !
I asked my consultant if I had actually displaced the Lisfranc alignment when I fractured all of the bones that I did, he confirmed that in deed I had & it was by a serious measurement. However If I continue to make the recovery that I currently am, he felt confident that the ligament & tarsometatarsals should heal well. I asked about my prognosis, he confirmed that subject to the good recovery continuing I stand a relatively low chance of developing a debilitating level of arthritis. The good news is that I stand no chance of developing arthritis in my 3rd TMT as I've already had the treatment by having it fused. If I were to present with painful arthritis in the future then he would treat it my fusing the rest of my TMT joints. I feel reassured that it would be treatable & actually if it came to this, well at least I'd still be able to stay relatively active. I have lost some feeling on the inside of my 3rd & 4th toes, my consultant said he couldn't say for sure if this would be permanent, but it shouldn't affect me too much. I also asked if I would be left with a permanent limp, he said that I would have a slightly displaced gait, but after 6 months or so I shouldn't have an obvious limp & should be able to walk relatively normally. It will take a full 12 months or so, before I will reach my full recovery. I should be able to sail again next year, OK so no pirouetting on the foredeck but I WILL be able to balance well enough on both feet to be able to sail.

So I can hopefully look towards the op in July, then around a month later walking in a normal shoe, a few weeks later discarding the crutches & being able to drive sometime in August.
Happy, happy, happy of Royal Tunbridge Wells !!!

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.