Happy New Year 2014 !

Gosh, 2014 already & in April it will be the third anniversary of my injury. I have been seeing posts from other Lisfranc victims via the Facebook page; www.facebook.com/LisfrancFractureClub & I often see questions & enquiries from newly injured people on long term pain, shoes etc. This got me thinking about how my situation has progressed & I remember only too well the uncertainty I felt & misery of the constant pain during the recovery process. I also remember the despondency that I felt when even 18 months later I still experienced severe pain after walking or being on my feet for a period of time. The doctors were reluctant to speculate on my prognosis, I think that this is probably something that most Lisfranc sufferers experience at some point from their medical team. I have had to work quite hard in the gym, with physiotherapists & personal trainers to rebuild the muscle & tendon strength etc lost during the none & partial weight bearing period of recovery. At times this has been embarrassing, frustrating & quite frankly slightly depressing, but interestingly the by product of this work has definitely been a significant reduction in the pain.
I still have the pins & a plate in my mid foot & I had a cuneiform fusion, whilst I do sometimes experience tenderness in my 3rd & 4th metatarsal joints I can confidently state that I am pain free most days. If I know that I will be on my feet for a long time then I prepare with perhaps taking with me a second pair of shoes & some Ibuprofen as I know I'll need to manage my foot. However the period of time involved has lengthened considerably from around an hour or so 18 months ago to 3-4 hours now. To be clear this is normally standing or walking in a court shoe on a hard floor surface, or walking quite vigorously. In thicker soled footwear or on softer surfaces I can be pain free for longer. I walk at a normal pace again these days & can even run if I want to. I won't be entering any marathons anytime soon though :-) Not that I wanted to run a marathon even before the foot !
I would advise anyone with this injury to seek expert help & advice on the physical rehabilitation as it will help you to get the best results possible. I am planning to go skiing again in a couple of weeks, this time for a whole week. I recently purchased my own ski boots with a custom fit boot liner so that should help too. I have had 19 sessions with a personal trainer to help me prepare for skiing. We have focused on weight bearing strength, lower back strength, hip, knee & ankle flexibility as well as upper body. At one stage I was leg pressing 120 kilos ! It has been hard, I have had to step outside my comfort zone & push myself to beyond it.
I can also wear high heels again, a two inch heel to work for most of the day is quite comfortable now anything higher is for special occasions only ! Stilettos are tricky, wedges or thicker heels work better I find as there is more support incorporated within the shoe design. The happy feet insoles I previously mentioned are also worth a try, the good thing about those is that you can insert them into any shoe & improve your comfort pretty much instantly.
Anyway this update may help I hope, don't give up it does get better !

Special shoes ! Not bad for a girl with a broken foot :-)

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 !!!