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.

Thursday 7th April

The next three days had been painful & awkward but luckily I was well supported by new boyfriend, my dad & my grandad who had all visited me & helped me out with cooking & general day to day stuff, eating takeaways, watching movies etc etc :)
So I attended fracture clinic on Thursday 7th April & after having my cast removed, the registrar looked concerned. The location of the bruising & the amount of swelling were atypical to a Lisfranc, I later found out.After having my back slab plaster removed, I went for X-ray & also attempted a weight bearing X-ray, returning to Fracture clinic to meet again with the registrar.....
An orthopaedic consultant appeared along with the registrar & with a grave expression on his face proceeded to explain that he thought it was highly likely I had in fact broken more than one bone along with injuring the Lisfranc joint. At this point I'd never heard of the Lisfranc joint, but the consultant then proceeded to explain I would need surgery, but this wouldn't be possible until the swelling had subsided. I was referred for a CT scan & fitted with a walking boot, although told strictly no weight bearing & to keep the foot elevated at all times to reduce the swelling as quickly as possible. A possible 3 month recovery period was mentioned & after now realising the potential seriousness of the injury I booked a private appointment to follow up the CT scan results with the consultant on Saturday 9th April...............

One bloody metatarsal cannot hurt this much ???

As I held onto the sink in my kitchen, big hot tears formed in my eyes & 9 hours after breaking my foot, I cried. My shoulders shook as I gulped back the sobs, eventually letting out a hopeless wail, my injured foot now bound up in plaster of paris hung down from my knee, bent to prevent it touching the floor. I remembered I had a few cigarettes left in my sailing bag (I've enjoyed a love/hate relationship with cigarettes since I was 17 & although I'd given up last January a few social & post race cigarettes had crept back into my life recently, normally accompanied by a lovely glass of red wine). I inched my way around my kitchen, hopping & pulling my self from the sink to the cupboard, to the cooker until I reached the kitchen drawer that I kept a lighter in. After hopping & pulling myself back round to where the crutches were I made my way to the living room, sat down & lit the cigarette. Inhaling deeply, it didn't taste great, nor did it help with the pain but somehow it comforted me just to smoke it, whilst I tried to comprehend how much impact this injury might have on my life.
I work as a technical sales person for a connector company within the defence & aerospace industries, lots of blue chip customers & I normally drive on average 800-1000 miles per week. I reasoned with myself that one fractured metatarsal should only mean 6 weeks or so in plaster, perhaps a week off sick, then a few more working from home, I could get someone to drive me into the office for a week or so, yes this isn't too bad I concluded. Far from ideal but not a total disaster, Internet shopping for a while & maybe someone to help me walk my lovely cocker spaniel. I sent a text on my blackberry to my boss & emailed my dad & my gorgeous new boyfriend to let them know that I wasn't contactable on my Iphone as I realised that this had been left behind in Southampton. New boyfriend I guessed had probably been trying to contact me, to see how my day had gone with the new crew & might be worried that he hadn't received a reply.
I took a couple more co codamol & decided to try & get to bed, yep it was a struggle, the crutches felt alien & unco-operative as i tried to get upstairs, my foot dangled precariously in mid air as I limped, dragged & hopped my way up the stairs to bed.

I must have slept, but can't really remember going to sleep as such. It was 2.45 am when I looked at my bedside clock, the pain was excruciating. The bottom arch of my foot felt like it was on fire, with a hard knuckle or ball being driven into it. The top of my foot throbbed, pins & needles shot up & down my calf & shins. My toes were swollen unrecognisably & a sensation of hot stabbing pins intermittently affected the tips of them. I tried elevating my foot & lower leg on pillows, but this just seemed to increase the strength of the pain, nausea swept over me & I writhed around in bed just trying to somehow find a position that offered some relief. I can honestly say even after experiencing childbirth, a childhood kidney complaint that frequently caused renal infections, a horse riding accident that caused a badly broken arm & significant muscle damage I have never known pain like this !

Sweating profusely & absolutely at the point of despair with the pain, I pulled myself out of bed, grabbed the crutches & made my way down stairs. I stood at the top of the stairs pondering the safest & most painless way to get myself & the cumbersome crutches down them. Eventually I decided, sitting down & bum shuffling was the way to go. Once down, I again hobbled into the kitchen in search of a cigarette, I noticed the co codamol on the side & after reading the dosage instructions, took one more, hoping that this just might take the edge off of it. I held on to the sink, smoked the cigarette whilst tears again rolled down my face. All the while my mind was questioning the diagnosis at A & E, how on earth could just one fractured metatarsal cause me to be in this much pain ?

After I'd calmed down a bit, I made my way back into the living room, switched on the TV & aimlessly flicked through the channels to find something to distract me from the pain. I persevered for another hour or so but it was hopeless, back I went to the kitchen, another cigarette I lit, it tasted foul, it made my head spin, it did nothing for the pain but feeling as wretched as i did, I smoked it anyway. Again another  wave of nausea & cold nerve tingling pins & needles came, this is no good I thought to myself, ring the hospital, this can't be normal. Anxiety & fear was creeping in at this point, it was nearly 4 am & I was on my own.

After a short time I was put through to the A&E sister on duty, I tried to explain to her what the pain was like & where it was, I also shamefully admitted I'd taken 3 co codamol within the last 3 1/2 hours, tears again rolled down my face in desperation & just bloody agony. She sounded tired & rather annoyed, she proceeded to lecture me about only taking prescribed pain killers as directed & then stated that the fracture I had was notoriously painful & I just had to bear it. So I did.

Good old NHS

With an icepack on my foot & it supported by the crew members coats, Peter the skipper drove me the 2 hr journey back to the local A & E in Tunbridge Wells, I found a seat & still in Musto & Dubarry's along with my bag of foulies & sailing gear I began to wait.....
After a while I hopped over to the reception desk & enquired if I should sign in or something ? The receptionist beckoned to a seat in front of her & began to take down my details, the foot was growing nicely at this point, along with the throbbing. After completing a few basic questions, nature of problem, name address etc, she then informed me I'd need to make my way to the minor injuries unit, which was a five minute walk or so through a few corridors. I politely asked if there was a wheelchair available, "no, sorry we're short of those today" she replied, so I picked up my bag & began to hop whilst holding on to whatever secure props along the way i could reach. Luckily, a rather nice chap saw the size of my now rather colourful & odd shaped foot & offered me his arm. On arrival in the MIU, he also found me a wheel chair & sat me down, passing the paperwork I'd been given to the reception desk, by now it was around 3 1/2 hrs since I'd done the deed.
After about another hour or so, I was feeling pretty sick with the pain, a Dutch woman (who was there with her daughter who'd fallen from her horse & had suspected concussion) noticed my discomfort & highlighted this to the medical staff. Along came a young doctor who after enquiring about allergies etc, gave me a couple of co codamol, all the while still no one had looked at or examined said foot !
Eventually after a takeaway from Wagamamas (also kindly provided by the Dutch lady) I was taken through for assessment, by now it was almost 10pm, 4 hrs after I'd arrived ! After X-ray lovely young doc, confirmed I'd broken a metatarsal & prescribed a back slab plaster, some co codamol & an outpatients appt at the fracture clinic in 4 days time.
Shortly after this, I was greeted by the lovely smiling face of a chap from the Phillipines, "Hi I'm Johnathan & I'm your plasterer" was his opening line, I resisted the urge to respond with a quip about his screeding skills. After a brief discussion about the size of the cast, I explained that the sailing trousers I was wearing were new & I was reluctant to lose them due to them not being able to be removed, Johnathan scratched his head for a while & looked a little embarrassed. A flash of inspiration then led me to explain to the lovely Johnathan that I had my very baggy foulie trousers (heavy duty sailing waterproofs) in my bag & suggested that if I removed the ones I was wearing until he had finished his 'plastering' I could then put these foulie's on to go home in !
Johnathan left me in the cubicle, I proceeded to squirm around on the hospital bed, whilst trying to wriggle my trousers down until they fell off of my feet. I then grabbed the hospital gown that had been left to spare my blushes, wrapped it around my waist & waited........
When Johnathan reappeared he looked a little embarrassed & explained that he needed me to lie face down on the bed, with the offending foot hanging over the end. Again I squirmed myself into position & found myself face down, with the hospital gown covering my bum & thighs & one leg bent up at the knee with Johnathan now sitting at the end of the bed with his bucket of water & plaster of Paris at the ready to begin his sculpture. Up to now, my foot had been permanently in a pointed toe position that would make most ballet dancers proud, Johnathan did his best to bend it back into a normal angle/alignment with my ankle & proceeded to slab the plaster around the back & heel to hold it in place. I grimaced & gulped, blushing red with embarrassment, becoming tearful & emotional with the pain in front of everyone was not an option, I'd already decided.
Plastering finished, I then pulled my foulies out of the bag, bright red dungarees with the grey all weather bum & knee patches, normal for sailing but obviously not really Tunbridge Wells fashion, there was no choice I concluded as I pulled them on, again squirming, a few grunts escaped as I managed to wriggle into them & sat upright. Armed with crutches I then wobbled precariously out of the cubicle, fully appreciating every pound of the 9 3/4 stones I weighed. How on earth am I supposed to be able to support myself & be mobile I wondered to myself as my biceps throbbed & shook in protest !
Dutch lady had become quite concerned about me & so kindly offered to take me home once my cast had set. Home is a maisonette contained within a three floor converted Victorian building, requiring a steep flight of stairs to get to the front door & then further conquering of another staircase to get to the loo...........
After getting me inside, Dutch lady left me with her contact details, along with a bar of Galaxy chocolate (emergency provisions) & departed. I was indeed deeply grateful for the kindness this lady who had in fact been a total stranger up until a few hours earlier, had shown me. Thank god for the good Samaritans on this planet !