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.

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 !!!