A lisfranc diagnosis is rare and often missed……
I wish my lisfranc story was more exciting. Wouldn’t it be more fun to tell people I sustained my lisfranc injury while skydiving in Brazil or snowboarding in Aspen? But my story is much less dramatic. I was celebrating the grand opening of a new restaurant with friends and we were on our way out when we saw some of my son’s friends sitting in the bar. I went over to collect my hugs and turned to leave, and missed the step down, falling off my 3 inch heels. I was mortified that I fell off my perch and tried to stand up right away, but my right foot was so unstable that I fell again. (I was hoping none of my sons friends were taking a video and that would end up on youtube the next day. )I took off my shoes, thinking the heels were the stability problem and my husband helped me hobble painfully to the car. I remember thinking how weird my right foot felt when I tried to walk on it. My foot felt wobbly and I didn’t trust it to hold my weight.
Lisfranc injury is indicated with severe bruising on the bottom of the foot
I was in a lot of pain that night and in the morning my husband took me to urgent care. The doctor took an x-ray (non weight bearing) and said I had not broken anything and that it was a bad sprain. I asked how to take care of it and he said Advil, elevation and rest. I asked for some crutches since It was too painful to put any weight on my right foot at all. I wish I had taken pictures, but I had the classic bruising of a lisfranc injury where even the bottom of my foot was severely bruised.
The Urgent care discharge instructions said that if I wasn’t better in 10 days, to seek additional medical attention. I waited the 10 days, and not only did my foot not get better, the pain and bruising got even worse. So I sought out my Podiatrist who had helped me in the past with plantar fasciitis. I brought a copy of my x-ray from urgent care and he agreed that it was not broken. Informing me that bad sprains take time to heal, he put me in a walking cast, the kind that goes up to your knee, and said to use that and crutches to get around.
Weight bearing x-rays are essential for accurate lisfranc diagnosis
I waited another 10 days and my foot was still not better. The bruising was still there and my pain was hovering at about a level 4. I decided to seek a 3rd opinion from a well known orthopedic center in Minneapolis. The doctor who had time to see me immediately was a surgical podiatrist. He looked at my x-ray and said he wanted to take one of his own as he suspected a lisfranc injury. This was the first time I heard the word lisfranc. I was brought into his x-ray room, where the technician had me stand on my injured foot for the x-ray. My new doctor than gave me the tragic news. We viewed the new x-ray together which showed a large separation between my first two metatarsals. He asked how the x-ray was taken at urgent care and I told him laying down. Lisfranc injuries are often missed because lisfranc injuries are seen easier on weight bearing x-rays where weight is on the mid foot area.
My new doctor then told me I was a few days outside of the optimum surgery window for a favorable outcome and that he would still be willing to do the surgery but it had to be done immediately on an emergency basis. If I didn’t have the surgery, I may never walk again and would have pain the rest of my life. I felt tears leaking from my eyes as he delivered this news. He went on to say that he would come in on Good Friday (2 days away) and do the surgery for me. That is how strongly he felt I needed immediate attention. He told me he would be putting a combination of plates and screws in my foot and would make up to 3 incisions and as he was talking, his voice started to fade in my mind. I was having a hard time accepting what he was saying. Next he explained that I would have to be non weight bearing and in a cast for 3 months, I felt my life completely collapse. I told him my husband and I were going to Israel with our church group and he said I had to cancel the trip. The trip we had looked forward to, planned for was gone!
The next few hours were a blur. I was seen by another physician in his group for my pre-op physical, I was given instructions for surgery prep. I was scheduled for my surgery plus 3 more post surgery follow up doctor appointments. I was given a packet on what to expect after surgery. A knee scooter was put on order for me and then an appointment was set up for me for a CT scan.
I walked to the parking lot and sat in my car and cried. I couldn’t believe this was happening to me! I wondered how I would ever tell my husband, not only about the surgery and the after care that it would involve, but that we had to cancel our trip to Israel. After I calmed myself down, I decided to drive to my husband’s office and tell him in person. He met me in the parking lot and I broke the news to him while sitting in my car. He was astonished, disappointed but was glad I had something that was fixable. It really bothered him, though, that this all was on such short notice. We both knew that for a major surgery we really should be seeking a 2nd opinion, but I was told I didn’t have time. Not if I wanted to walk again.
My husband decided he was going to find a 2nd opinion and find it fast. We both knew that would be a long shot since all the top orthopedic surgeons are booked weeks in advanced. He started by calling his primary care physician and asked who the top foot specialist in the twin cities was and was told the name of a doctor who works out of Twin Cities Orthopedics and that this surgeon was a “doctor’s doctor.” AND he took care of the Minnesota Vikings players feet. Well my husband left 3 messages with the surgeon’s assistant that he wanted the surgeon just to take a look at my x-ray and tell us if it really was a lisfranc mid foot fracture and if emergency surgery was indicated. We didn’t hear back from the assistant, so my husband decided to hand deliver the x-ray to this surgeon. Meanwhile, a dear friend of ours, who co-owns the building Twin Cities Orthopedics offices in, called in a huge favor and had one of the owners of Twin Cities Orthopedics call the surgeon and ask him to take a look at my x-ray.
The next thing I knew, the surgeon called me on my cell. He said that after looking at the x-ray, he didn’t think lisfranc surgery was indicated. I was stunned! I told him what the first doctor had said and that I was scheduled for surgery in the morning and he said that it was not true that this was an emergency and that I would not walk properly again if I didn’t have surgery right away. I asked him if he would like to see my CT scan and he said yes and could I bring it to him right away.
Lisfranc surgery is elective surgery
When I arrived at Twin Cities Orthopedics, I felt like a celebrity. There were sticky notes with my name on them saying not to let me leave before seeing the surgeon. I was ushered into a room and waited. Shortly afterward the surgeon walked in smiling and commented that I had friends in high places. I liked him immediately and felt calm settle over me. His aura was one of quiet confidence. He pulled up my CT scan and showed me various pictures of my foot. He said with this new information he would have to reverse his opinion and that I did indeed have a lisfranc mid foot fracture with ligature rupture and joint displacement. Surgery, however, was not an emergency, but rather a choice.
Choose your surgeon carefully and inquire about their recovery protocol
I explained to him about our trip to Israel and how disappointed I was to have to cancel but that walking properly again was more important to me. I also asked him if he was taking new patients. He said “apparently I am.” and smiled. He then told me to go ahead and go to Israel. I was stunned! He said his surgery schedule was 6 weeks out anyway, so he would put me in a walking boot and if I wanted to go, I could. I had to promise him that I would “listen to my foot” and not push myself if it hurt. And then he promised me that he would be able to fix my foot and that I would be able to walk without pain again. I felt tears of happiness slipping down my cheeks as he delivered this news. As he stood up to leave the consult room, he turned to me and said “you will cancel the surgery for tomorrow, yes?” And I said absolutely.
So my husband and I loaded up with Advil, instant ice and my walking boot and and headed to Israel for a life changing marriage changing experience.
When I returned I had an appointment with my new surgeon who took another x-ray and confirmed that I still needed to have the surgery. This time, I knew I had the right surgeon operating on me.