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Roz Clarke

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Hoppy New Year [Jan. 5th, 2010|05:40 pm]
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All the best for 2010 to everyone. May it bring you much health, wealth and happiness, and not too much freak weather.

I'm intending to forget 2009 as best I can, as soon as possible, and put my best foot forward into the new decade. It's easy to tell which foot that is: the one without the blue fibreglass armor.

For the benefit of anyone with a similar injury desperately googling for info, and anyone simply in need of a bit of broken-bone schadenfraude, details of my Lisfranc dislocation-fracture are under the cut.

At the end of October I fell out of my landspeeder / leaped from the boarding ramp of a departing flying saucer / was thrown by a llama / slipped on the stairs (delete as preferred), landed awkwardly on my right foot and discovered a kind of 'ouch' hitherto not experienced by me. Still, I figured it was just a bad knock and all would be well by morning.

Come the morning, of course, the foot was doubled in size and developing black streaks, so my dear friend Paddington, more or less stifling her giggles, drove me to the accident unit. An x-ray (which I'm trying to get hold of and will add if I do) showed a jagged edge to one of the little square bones in the middle of my foot and a widening of the joint between the 1st and 2nd long bones at the front of my foot. I was put in a backslab and given a mismatching pair of crutches and a referral to the fracture clinic.

Rather stunned to have done real damage, I spent a jolly hour driving round ASDA on an electric buggy shopping for ready-meals, and went home to spend the next 10 days crawling up and down stairs and trying to self-diagnose via the intermawebs.



I am really bloody good at making medical diagnoses via the intermawebs. No, really. I figured out my cat's diabetes and my sister's dog's torn cruciate ligament when the vets were scratching their arses. Still, it took a long time to nail this one. However, by the time I got to see the Mr. at the fracture clinic, I was able to say the phrase "Lisfranc dislocation fracture, indicated by avulsion fracture to the lateral cuneiform, displacement at the bases of the metarsals, severe pain on rotation and deep discoloration to the underside of the foot," with a good deal of confidence.

The Mr. was not impressed of course; being smart about stuff is his job, and patients that read the intermawebs are a pesky nuisance. I think that was possibly the point at which he decided he wasn't going to discuss my foot with me ever, ever again. I was right though.

The Lisfranc joint (also known as the tarsometatarsal articulations) is named after Napoleon's surgeon, Jacques Lisfranc de St. Martin, who first described this injury. At that time it was most commonly caused by riders falling from their horses but having one foot caught in the stirrup. Amputation was not an uncommon treatment; mercifully this is no longer the case.

To oversimplify it a bit, the ligament that kissed bye-bye to my lateral cuneiform acts like a rubber band that holds all the joints of the mid-foot in place. Without it, the mid-foot collapses, and in particular the 1st and 2nd metatarsals can separate, as they have no connecting tissue between them. So what, you may wonder. Well, this joint complex needs to be able to support your whole bodyweight under force. An open joint doesn't function so great, you wind up with a flat, rigid foot and arthritis becomes a given. What to do?

Screw it, is the answer. As in, with screws. I am scared - I'm getting my first go at a general anaesthetic. Ten days later I'm on the slab, I've been asked my name and date of birth by seven different people and the Mr. has taken precisely 1.5 minutes to tell me what he's going to do. Luckily the anaesthetist is adorable so I feel looked after. Oxygen mask, cannula, a count of ten and everything slips away.

I wake up, if you can call it that, in the recovery room surrounded by worried faces and beeps. The mask is still over my mouth and nose and there's a nurse holding one of my hands and the anaesthetist holding the other. The 'ouch' I discovered when I first fell has nothing, NOTHING, on the pain now lighting up my foot like an electrical storm. There's a forum where people with a Lisfranc injury go to scare the feck out of each other with their grisly tales of smashy-crashy. A couple of the women on the forum had posted about the post-op pain, both claiming that they'd had med-free childbirth that was considerably less painful than this. That hadn't really sunk in when I read it, but oh my, I found out what they were trying to tell me.

There's this nerve that runs down the top of your foot, called the medial plantar nerve. It branches out to serve the front of the foot and the toes. I'd had to sign a disclaimer prior to the operation confirming that I accepted the risk of nerve damage. I signed it all right, having little choice, but vaguely assuming that it wouldn't happen to me. If you look at a diagram of the nerves of the foot, such as this one , you can see that the nerve runs right through the space between the 1st and 2nd metatarsal joints. Where I now have a titanium screw. Other screws were merrily driven through other sections of the nerve. Nerve damage hurts.

Eventually (after an hour and a half or so - I was facing a clock on the wall) they gave me enough morphine to allow me to breathe again and not pass out, declared my blood oxygen acceptable and sent me back to the ward. Three hours later, having emptied my system several times into a bedpan shoved under my tush by a very, very nice lady called Rosa, and had a successful practice at standing up, they called my dad to come fetch me. Dad and Paddington watched over me and provided fish & chips, which I ate enthusiastically and failed to keep down.

Since then I've been non-weight bearing - 10 weeks in total now - and the pain has gradually eased off. The muscle has melted off my calf and I've had to have progressively tighter casts put on. I got a look at my foot when they changed the cast at the first follow-up, and I have three incisions, which all itch and sting from time to time. The whole thing aches when my foot gets cold, which lately, what with the three weeks of snow'n'ice we've had in Blighty, it does every time I go outside, and also when it gets hot. The tendons have tightened dramatically and my toes do not flex much, and I get the wierdest pins and needles in the bits of my front-foot I can still feel. I've lost sensation completely in an area about three inches in diameter, where the nerve has been severed.

For the past couple of weeks I haven't really needed to keep it elevated, and for a few days I have been experimenting with touching it to the ground for balance when using the crutches, which has gone very well. I'm looking forwards to finding out when I can transfer to a walking cast, and get stuck into the physio to build the muscles back up and regain my balance.

Some surgeons prefer to have the screws out before you start weight-bearing, in case they break, others leave them in for good. Mine will stay in for around 18 months, then it's back on the table to have them whipped out. Hopefully they can't wreck the nerves any more than they have already. I should be back to full fitness by then, apparently. I can believe it will take a year to rehabilitate: my sprained ankle did. In fact, two months of hopping on my bad ankle is what's finally done the trick in returning it to full strength!

The prognosis is a 58% chance of arthritis in the Lisfranc joint complex, even with the surgery, but I'll take that over 100% and a limp, any day.

Three things to take away from this experience:

1) Thanks be for free, universal healthcare. NHS, I kiss you.

2) Don't run about in socks on uncarpeted stairs.

3) Love your feet, guys. They are complicated and amazing and deserve your gratitude for doing a difficult job well.
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Comments:
[User Picture]From: therinth
2010-01-06 08:21 am (UTC)

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holy shit Roz! *hugs!*
From: samm_on
2010-06-28 09:44 pm (UTC)

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Terrible experience, I don't know if I could stand so much pain. I hope you're paying attention to the painkillers you're taking, some of them have a nasty side effect, they are addictive. People in oxycontin rehab would have more useful advises to give you. I hope you're fine now.
From: jabadanelia
2010-12-29 04:26 pm (UTC)

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Very impressive description but I've noticed one thing: your bandage is not signed. Mine was signed by the entire college football team and I'm still proudly keeping it in the basement.
Seattle chiropractor