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2 days after lisfranc hardware removal surgery

 
 

 

 

 2 days after my lisfranc hardware removal surgery I was told to remove the dressing and ace bandage.  I wasn’t sure what my foot would look like, and I was surprised it wasn’t more swollen.

 
 
2 days after lisfranc hardware removal surgery

You can still see where my surgeon placed his initials and where I signed “yes!” indicating my right foot was the correct foot to be operating on.  My surgeon used the exact same incision for removing the hardware as he did for my original lisfranc surgery repair.

 
 
lisfranc hardware removal incision
 
 
 

After a shower I had to let my incision air dry and I needed to elevate and ice, something I know how to do!  My nurse told me the ice doesn’t have to be over the incision, and that icing the ankle will help just as much.  That knowledge came in handy since the incision area is very tender!

I have been keeping the incision covered with a large band-aid which protects the area from germs.  I remove the bandage daily to make sure the area around my stitches is not turning red with infection.

Lisfranc hardware removal surgical site

I have been meticulous about staying off my foot as much as possible and have been icing and elevating most of the time.  This has been hard, psychologically, for me because it seems like I have gone backwards in my lisfranc journey.  But I know, that in a little more than a week, my surgeon will remove my stitches and I will be able to resume walking again, and this time, I hope it will be pain free !

lisfranc hardware removal surgery
 
Last Wednesday I went in for my lisfranc hardware removal surgery.  I requested the same nurse that I had for my lisfranc surgery and was thrilled when she came to get me from the waiting room.   Nurse “Emily” is the perfect combination of humor and empathy with the ability to convey information in a way I can hear.   
In preparation for my surgery, nurse Emily got me into a heated gown, and covered me with heated blankets, which made me feel like I was at a spa.  As she started my IV and explained exactly what was going to take place, I shared that I  wasn’t nervous about the surgery itself, but was really anxious about the pain and recovery period.  As we were talking, Emily took my blood pressure and it was 168!!!!
 
Nurse Emily immediately started re-assuring me that it would be nothing at all like my last surgery and that I would be feeling “normal” in a few weeks.  Then my surgeon walked in, calm as ever, and with a reassuring smile asked me how I was doing. Since it was nearing the end of his surgery day, I immediately asked him if I could buy him a cup of coffee.  He laughed and said he was plenty alert for me.
 
 He reassured me that this surgery would be nothing at all like the last one and then talked with me in depth about the kind of anesthesia I would be having.  The biggest question I had was whether I would have to go another 6 months with my big toe and the top of my foot being numb.  We decided together that I would not have a nerve block unless I absolutely needed one which would cut down on the likelihood of lingering big toe numbness.
 
After he signed my right foot and turned to leave, I told him that the anesthesiologist said I couldn’t watch the surgery.  He smiled and said, “bummer.”  
 
When he left, I was a lot more at ease with what was about to happen.  Emily shut my curtains and told me to rest until it was my time, which turned out to be 1 1/2 hours!  I have never sat in a room, with nothing to read and nothing to do for that length of time. Unrestrained thoughts can be a dangerous thing!
 
Finally, my surgical nurse, Sarah, came to get me and she and the nurse anesthetist  wheeled me into the operating room.  The operating room was quite cold and when I mentioned the cool temperature, I was asked to transfer to the operating table with the promise of more warm blankets.  The operating room table was really narrow and did not have space to put my arms by my sides. While I was still trying to decide where to put my arms, someone took my arms and placed on side tables located on either side of the operating room table while someone else secured a thick strap over my stomach.  I asked why the strap and was told it was so I wouldnt fall off the operating room table during surgery.  About  now I was starting to get a little creeped out, and as I was staring up at the ceiling at the many bright white lights that looked a lot like  spider’s legs, a mask was placed over my mouth and nose.  I was very happy to succumb to the anesthesia!!!!!
 
It felt like only a few minutes when I woke up in recovery with my nurse Sarah asking me if I had any pain.  As I slowly came to, I felt a searing red hot pain in the top of my right foot and noticed tears starting to stream down my face.  I told nurse Sarah I was quite uncomfortable and she said I did not have a nerve block and that they needed to control my pain with meds instead.  She immediately gave me a couple of opiates and some crackers.  After about 20 minutes my pain level decreased from a 7 to a 3 for which I was grateful.  After getting my pain under control I was offered ice water and I can honestly say, no ice water has ever tasted so good!!
 
My surgeon came in smiling widely and told me everything went extremely well and asked me if I wanted to keep the hardware he removed from my foot.  I told him I planned to take pictures of it and post it on my blog and keep it next to my boot.  He laughed and  said they would sanitize it and mail it to me.  Eventually, my pain remained under control and I was told I could return home, where I have been mostly in bed, sleeping and occasionally visiting with family and friends who have been care taking me and my husband.
 

lisfranc hardware removal surgery ice and elevation and a cute new surgical boot
 
 
 

27 weeks post lisfranc surgery with more surgery tomorrow

After recovering from lisfranc surgery for 27 weeks, my husband and I took a quick trip to Florida before I head back into surgery tomorrow.
I was not able to walk barefoot on the beach, and sandals were still uncomfortable, but that didn’t stop me from being able to enjoy the feeling of sand on my toes!
27 weeks after lisfranc surgery

I decided to be really adventuresome and try walking through Sea World.  We took it slow, and I was able to manage walking around the entire park and enjoy several of the shows!

After visiting Sea World, I even managed to walk through the airport to catch our plane. When we got home last night, all it took to be pain free was a little ice, elevation and tylenol!!

Tomorrow I am having the hardware removed from my foot.  I am not at all nervous about the surgery itself, but am apprehensive about the recovery.  I have been assured by both my surgeon and his nurses that recovery will be much easier this time, but I still wonder how long it will take to recover to the exact point I am now.  I have worked hard to regain almost normal walking and I dread going backward.

I know, though, for a positive long term outcome, hardware removal is necessary

I am celebrating today!  
 
Ever since I had lisfranc surgery  my mantra has been, 
“I am just a middle class housewife who wants to be able to walk down her driveway and get her mail.”
 
This dream doesn’t sound unattainable until you realize our driveway is not a short driveway with a mailbox at the end.  Nope.   Our mailbox is located exactly 1/10 of a mile from our garage door and our house is perched on top of an immensely steep hill, which makes it perfect for sledding in the winter. 
 
walking a hill after lisfranc surgery
 
 
My physical therapist and I discussed the possibility that I may be ready to take on “the driveway challenge” and he ultimately gave me permission to try walking up our driveway and see how that goes, before trying the harder challenge of walking down the driveway.
Walking up a hill during lisfranc recovery
 
 
So, after coming home from church today, I had my husband drop me off at our mailbox so that I could make my first attempt at my driveway dream.  I knew that if I ran into trouble, my husband would come down and pick me up.  My taxi ride may be on his John Deere instead of in a car, but at least I knew I had a ride if need be.
 
 
 
Pain free while climbing a hill 22 weeks after lisfranc surgery
 
 
I was apprehensive, wondering if my foot was physically able to make the climb, and I was also curious if scaling the hill would cause pain.
 
22 weeks post lisfranc surgery and walking up a hill

 

After managing the steepest part of the journey, I knew I was going to make it all the way to the top AND I made it 
PAIN FREE!!!

Next challenge—walking down my driveway!

Before I ever heard of a lisfranc fracture I took my feet and my ability to walk for granted.
Normal feet before a lisfranc injury

I was diagnosed with a lisfranc fracture of my first two metatarsals  with ligature rupture and joint displacement and on May 10th, 2013, I had this titanium plate inserted into my foot.

 
 
 

Lisfranc fracture repair X-Ray
 
 
 
Lisfranc fracture repair X-Ray 

2 weeks after surgery, I had my cast removed.

 
 
2 weeks after lisfranc fracture surgery
Today, 22 weeks after my lisfranc surgery, my foot is almost healed!  I am approximately 75% – 80% of the way to the finish line!
 
During my 27th physical therapy appointment, my therapist was astounded at my progress just in this past week.  I was able to get through my exercises with little to no pain, even when he decided to make them harder and more challenging.  

 
 
 
 
 
 
22 weeks post lisfranc surgery
 
In the midst of my weekly foot massage and manipulation, I was mortified that my therapist noticed I was beginning to get callous’ on my recovering foot. ( I had made sure I received a pedicure before my appointment, so that my feet would look acceptable. ) He laughed when he saw how horrified I was and quickly explained that callous’ were a good thing and showed him I was healing. Callous’ mean that I am walking more and that my skin is starting to toughen up just as it is supposed to.
 
I shared a story with my therapist about how I woke up during the night, thinking I had a spider crawling on my big toe, which is still partially numb.  After snapping on the light and assuring myself I was not in bed with a spider, I realized what I felt was the sheet on my big toe!  Finally, after 22 weeks, I can feel a sheet sliding on the top of my foot!!!!!!  
 
 
 
lisfranc surgery image 22 weeks post op, right hand side
 
During my appointment my therapist worked with me on activities I can start to do at the health club ON MY OWN!!!  
 
At home, I can now be on my treadmill for 10 minutes a day.  (Forward, backward and sideway walking.)  I have permission to increase the amount of time slightly each week, because I promised to listen to any type of foot discomfort.
 
 

lisfranc surgery image week 22 left side view
It helps that my therapist is encouraging, patient, kind and is also my biggest cheerleader.  I am absolutely thrilled with my ability to walk forwards, backwards, sideways and with my strength to balance on my toes.  
 

 
But there is sadness to this process too.  I will soon be saying “good-bye” to the man who gave me back my ability to walk again.  Countless times he calmed my fears and patiently explained to me, in detail, what was going on during my recovery. Picking the right lisfranc surgeon is crucial, but having the right physical therapist is indispensable! 
 
 
22 weeks post lisfranc surgery image

21 weeks after my lisfranc surgery, my pain level when walking has significantly decreased with some steps that are completely pain free. 
 
My physical therapist gave me a band which I use for my  stretching exercises.  I have found that if I do these exercises in the morning, it helps take the stiffness out of my foot for the rest of the day.
 
 

Physical therapy after lisfranc surgery

             Here are the other exercises I do daily to help me
                                 recover flexibility. 


 (These exercises are hand tailored for me at 21 weeks following lisfranc surgery and may not be right for you.  Check with your Doctor, surgeon or physical therapist before doing any of these exercises as your needs and abilities may be different from mine.)

Lisfranc physical therapy exercises at 21 weeks after surgery

In addition, I am walking on the treadmill for 6 minutes at 1.5 MPH and walking backward on the treadmill for 2 minutes at .8 MPH.

My insurance authorized 20 physical therapy sessions and when I used them all and was only 45 -50% recovered, my physical therapist fought hard to get me 8 more sessions.  I have only 2 sessions left and am not ready to say “good-bye” to the safety of the therapy room.  And I am dreading saying good-bye to my therapist who has painstakingly taught me to walk again……

 
 

21 weeks post lisfranc surgery

 
 
 
 
 
After 21 weeks of lisfranc surgery recovery I can now easily stand on my tip toes AND keep my balance without hanging on to the counter.
 
21 weeks after lisfranc surgery

My physical therapist told me I was about 65% – 70% of the way to full recovery.  I resisted the urge to hug him when I heard this news.  
 

 
21 weeks post lisfranc surgery left side view

 
In physical therapy this week, my therapist tied both my legs together with a band and had me walking sideways.  This action put a lot of pressure on the inside of my recovering foot which is where most of my pain still resides.
I was pleased this new exercise didn’t cause any additional pain, but rather gave me new confidence in being able to side step.
 
lisfranc surgery scar week 21
 
 
I can now walk not only forwards and backwards, I can walk sideways pain free.  This new ability came in handy when my husband and I went to a movie and had to crawl over people by side stepping  to our seats.
 
21 weeks post lisfranc surgery right side view
 
Having gained confidence in my ability to move in any direction, I am experimenting with leaving my cane in the car.
 
 
To remain pain free, I have to walk slowly but I can now maneuver out of the way if need be.  I am continually amazed at how fast everyone walks and wonder why everyone always seems to be in a hurry.  It is like I am moving in slow motion and everyone else in fast forward. 
 
If I try to speed up, pain takes over, so for now, I will be content to watch the blur of people darting past me.
 
21 weeks post lisfranc surgery
 
 
 

I had a setback a few days ago and my foot has been extremely painful when walking.  I rested it for 3 full days and then had physical therapy yesterday. My therapist took it easy on me not wanting the muscles to get irritated again.    After walking today doing normal activities, it is once again very sore.  I think this picture shows how swollen the top of my right foot is compared to my left

 
18 weeks post lisfranc surgery

My scar is still noticeable, but now I am more concerned about walking pain free. My goal is to walk without a cane and sneakers!

 
 
 
 

 

18 weeks post lisfranc surgery scar

 

18 weeks following lisfranc surgery left side view

This picture shows what happens when I push myself too hard.  The bump (swelling) on the top of my foot is at my incision sight and causes pain when I walk. I am trying not to wonder if I am always going to have pain when walking and swelling  when I rest.  I am back to icing tonight!

17 weeks post lisfranc surgery setback
Icing and elevating again



When I woke up today, I could not walk a single step without a pain level of 5.  Each time I tried to follow through with a complete stepping motion, I felt a sharp stabbing pain in my mid-foot, right where it needs to bend.  The pain was so immediate and intense that it caused me to suck in air to try and manage the 

onslaught of stabbing discomfort.


 I thought about canceling my Physical therapy appointment because I knew there was no way I could do any of the physical and balance exercises.  But in the end, I thought it might be important to talk with my therapist about my pain since it is very different from any of the other pain I have experienced during my lisfranc recovery.


I am sooo glad I went!  My therapist meticulously sorted through my activities from the last 2 days while massaging and manipulating my foot.  Together we pinpointed exactly which part of my foot was sore and which muscles were involved.  He also noted that my mid-foot was swollen in the exact places that were painful. 


Turns out that once again, I have overdone trying to be “normal” walking person again. Yesterday in HydroWorx therapy I was walking fast against the jets and played catch with a beach ball.  All of which puts a lot of strain on my mid-foot.  In addition, the water level was a little lower than usual.  I did ice after HydroWorx thinking that would keep my foot from swelling.


In the afternoon I went to the Parade of Homes which requires that you take your shoes off while walking through the rooms.   The muscles used while walking have to work twice as hard when you walk barefoot and my foot was not used to this new intensity.  


So today my therapist did a lot of massage/manipulation followed by electrotherapy with ice.  I was concerned having a titanium plate in my foot would be painful with electrotherapy, but it actually felt great!  And of course ice ALWAYS helps.  I am so thankful I have a therapist who took the time to listen and got to the bottom of not only where my pain is, but what most likely caused it to happen.  


After talking with my therapist, I am not worried about the intensity of the pain anymore and know it is just a matter of doing too much too soon.  The harder part for me now is that once again I am stuck at home, sitting in my favorite chair, elevating and icing for the rest of day.  I just hope tomorrow I will be more mobile again otherwise it will surely be another day of rest for me!

 Remember the last time your foot “fell asleep” and you tried to stand on it?  As it wakes up you feel tingling and eventually it feels like needles being poked into your flesh.  As the nerves in my foot regenerate, I have had that feeling multiple times on the top of my foot and especially in my big toe.But lately, the feeling has become more intense. For the last couple of days, my big toe feels like it is being stung  numerous times by small bees, not just on the top of my big toe, but underneath as well.  It is a different kind of pain than the feeling of needles in my foot.  It is a sharper intense “ZING” sort of pain which makes me suck in my breath.  It only happens when I am at rest and not when walking on my foot.

I talked to my physical therapist about this today and he said this was great news! To be able to feel sharp intense pain in a toe that has been numb for 17 weeks means my feeling is starting to come back in full force.

In addition, regaining feeling in my big toe is integral to being able to put weight properly through my entire foot.  When I can’t feel if I am transferring weight through my big toe, I cannot make the proper follow through for walking.

My therapy session today included .13 miles on the treadmill (1.5 miles per hour for 5 minutes) and 1 mile on the stationary bike.  I also did leg lifts, calf strengthening and lots of balance work on the bosu ball.  My new therapist is gentle and kind but makes me work up to my potential.  I am so glad my insurance cleared me for 8 more therapy sessions, which means my total for lisfranc surgery recovery will take 28 sessions.  (I have also had 36 HydroWorx sessions as well.)

As far as pain free walking goes, I tried walking through Macy’s today without my cane and in my sneakers.  I had to walk slowly and very carefully, but I was able to do it with a minimum amount of pain!  I was stiff,  but it felt more like when you first wake up in the morning kind of stiff and not the “I have to sit down right now” kind of stiff.

After Macy’s I went to Kohls and also left my cane in the car for that errand.  There again, I walked at a snail’s pace, but I did it!!!  I cannot tell you the amount of pleasure I got from walking through 2 stores without any assistance and almost pain free.

I am spending the rest of the day resting in my chair, (with ice) but I am satisfied, happy and have a sense of accomplishment that I haven’t felt since before my lisfranc injury.  There is light at the end of this lisfranc recovery after all!!!!

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