Lisfranc Injury: what will my mobility be like, and how do I move to NYC?
May 29, 2010 1:44 PM   Subscribe

I fractured my second, third, and fourth metatarsals, my medial cuneiform bone, and I have what is called a Lisfranc injury in my left foot. How much mobility will I have as the healing progresses? How can I prevent gaining weight and stay in shape? How the heck am I going to move to Manhattan?

While playing kickball last Sunday I fell and landed funny breaking four bones in my foot. My surgeon advocates surgery to put three plates in my foot to correct the Lisfranc injury. I will be in cast for two weeks, then in a boot for three months. The first six weeks in the boot I can't put any weight on my bum foot, and after that I can gradually add weight for the next six weeks. At four and a half months after surgery the plates will be removed and I will be able to walk with orthotic shoes. My doctor says it will be around Christmas before I am anywhere close to my original mobility.

This would all be fine except that I plan to attend graduate school at Columbia in New York City this fall, and I am afraid my reduced mobility will make attending class very difficult. Does anyone have experience with this injury, or similar mid-foot injuries, and how did your mobility progress? What can I do while I am laid up to stay in shape and perhaps promote healing? Any pointers on finding an apartment in NYC when you have limited mobility? I have already contacted the admissions office to see if they have on-campus housing for injured students.

Bonus question: I keep getting asked, "So you fell during a kick ball game eh? How did you fall to hurt your foot like that?" I am getting really tired of reliving my injury in detail, and trying to explain the kinematics of this freak accident. What are some snarky and polite retorts to this question.
posted by kscottz to Health & Fitness (18 answers total)
Best answer: What are some snarky and polite retorts to this question.

"Kick ball? You must have misheard me. I said brick ball. It's all the rage, these days"
posted by griphus at 1:54 PM on May 29, 2010

Might be worth investigating deferring the start of grad school a semester? Sounds like a really challenging situation between moving, new school, presumably new city. Good luck!
posted by leslies at 1:58 PM on May 29, 2010

Oh, man. That sounds painful. I fractured and displaced my fifth metatarsal about a month ago, and while that's not as serious as your injury, I got some good tips on moving house and crutching around in the city.

You will get really good on crutches. I was on two for 3.5 weeks (down to one since, although my recovery timeline is, again, shorter) and did (do) over a mile walking plus subway and bus on the way to work. It really sucks. I was only non-weight-bearing at first, and then for about another week (about a week ago).

The extra week of random non-weight-bearing was because I started getting severe calf pain from losing flexibility/range of motion. I am not sure how or if this could have been prevented, but it was not fun and one of the most painful things that has happened to me. See if your doctor, or even a consultation with a physical therapist (because I assume you won't have PT for a while) can give you appropriate stretches, etc.

Staying in shape: Swimming has been highly recommended to me, though I haven't been yet because it's not very easy to get to the public pool for me. Apparently there are blocks that can immobilize your feet so you don't kick. The exercise in the later stages of healing is supposed to be good, and swimming is good because it's low (no?) impact. Ask your doctor, though, if this is good for you. I haven't gained any weight, but I think that's because I'm still "walking' a lot.

Finding a house: I would really minimize stairs, as even now they freak me out. As far as moving - it was a pain packing on crutches but doable. We hired movers for the actual moving. I can't imagine another way, honestly. I am still not unpacked, and it has been 2 weeks, but I made it here.

Everyone in DC has seemingly asked me about my foot - co-workers, cab drivers, bouncers, strangers in the Metro elevators. I end up being as polite as I can manage, simply because the goodwill of strangers has been so great. It wears on my patience, honestly. I fell on some stairs in broad daylight sober, so people ask me how I did it to. I tell them, "unlucky, I guess!" and then don't have to deal with the prolonged explanation. Headphones, even when not listening to music, provides protection.
posted by quadrilaterals at 2:08 PM on May 29, 2010

Dear god whatever you do listen to what the doctors told you and stay off of it. I broke my foot in two places three years back. First doc said it wasn't broke and basically told me to walk it off. After almost a week of trying to "walk it off" I finally went to another doctor who said it was broken in two places. I have since broken the same foot three times because it didn't heal right. Each time after that I would be able to hobble on my foot after about 3 weeks with pain and like a stubborn tough guy I would start to walk on it because I hated the crutches so much. To keep from getting fat watch what you each, curb your drinking and work out with your arms as much as you can. If you can find one of the sitting arm bikes those are perfect. Curbing your drinking will not only help you from getting fat but also prevent you from walking on your foot after you stop feeling so much pain.
posted by no bueno at 2:10 PM on May 29, 2010

As for apartments: what's your budget?

Apartments near Columbia will obviously be expensive, but the closer you are to its campus the less you would have to rely on the subway. The subway on crutches is not an easy thing to manage, especially if you're carrying books. To be rather blunt, you will find yourself navigating narrow stairs frequently, with people pushing past you to get up/down, and you will quickly get frustrated.

I'd do everything possible to get off crutches before your school starts up, or else defer admission until you're healed.
posted by dfriedman at 2:20 PM on May 29, 2010

Best answer: You will get *in* really good *shape* on crutches.

After my ankle surgery I spent 8 weeks on crutches and it transformed my upper body. Didn't hurt that I twice had to evacuate from the 27th floor of my office building during a fire alarm. (yes, 27 flights of stairs - tip: both crutches under one arm, other arm uses stair rail for support).
posted by toodleydoodley at 2:21 PM on May 29, 2010

You can also get one of those knee scooter walker things, like this one. They're great for the office, or home, or even something like Target that requires a lot of walking (tho you can usually get a motorized scooter there). There are cheaper ones out there, and you'll be able to rent it somewhere too. A nice break from crutches.

Also, hire packers if at ALL possible. They make moves so much easier.

Sorry about the injury. It truly truly sucks having a summer and plans screwed up like this. Do your best to keep your wits and patience about you; what's done is done, and from hereon out you can only control (even then, to the extent it's possible) your own reaction to it all. Be the person that seems to adapt and not be super prickly about it, and folks will want to help more.
posted by barnone at 2:31 PM on May 29, 2010

Best answer: Oh crap, sorry that happened. About two years ago I broke my fifth metatarsal after, duh, falling off a ladder. "Time wounds all heels."--Gilbert Sorrentino. This was one week after starting a new job which required a fair amount of travel. It was a spiral fracture along the length of the metatarsal--not a clean break across it (which I think actually may have helped it heal faster). My injury wasn't as extensive as yours, so I was able to get away with wearing a stiff-soled velcro boot/shoe thing for about a 4-6 weeks. Then I was able to start wearing normal shoes, and walking somewhat carefully. About 2.5 months after the accident, I was pretty much normal and my orthopedist declared me healed ("But go easy on it"). I continued to feel twinges of pain in my foot for as long as six months after the accident...but at this point I was able to go on fairly brisk walks and hikes.

Throughout, I lifted weights on my couch and got the heart rate up playing Wii. Not very much though. This was about it as far as exercise was concerned. I made sure I got lots of calcium and vitamin D, ate spicy foods (the idea being this would help with blood flow to my extremities), and slept with a wool sock on my foot to keep it warm at all times. These things probably made little to no difference...but it's good to feel like you have some control over an extended healing process.

You're just going to have to be patient and see how the healing goes this summer. I wouldn't be surprised if you were pretty mobile by mid-September...but I guess it depends on a lot of factors. If it were me, my mindset would be: "I am GOING to grad school even if I have to hobble around the entire first quarter." I would think that by that point, moving as much as appropriate will help the healing process more than hinder it (IANAD).

Oh, you should get one of those knee-scooter things during the non-weight-bearing interim.

This is a great reason to have the laziest summer possible, resting up your brain before grad school begins.
posted by bennett being thrown at 2:34 PM on May 29, 2010

A wheelchair would be best for getting around.
posted by JayRwv at 2:48 PM on May 29, 2010

Response by poster: My price range for an apartment around Columbia was in the 800-1200 range. The upper range would be for a one bedroom or an efficiency. I have considered differing graduate school for a semester, but the Columbia website makes it sound like that is not a possibility. I am looking into the kneeling walker, and I should know next week.

I asked my doctor about physical therapy prior to being out of the boot and he kinda waived it off. He did say that swimming was out of the question as my foot needs to stay stationary as possible. This does sound like a really good excuse to buy a Wii though.
posted by kscottz at 3:22 PM on May 29, 2010

I did what I thought was a controlled slide on my fingers and toes twenty feet down a rock face I'd just climbed up toward a sandy beach, but when I hit, my right tibia split half way up to my knee as it was forced down over the talus bone on either side. I hung around the house for three days claiming it was just a sprain until my ankle looked like a nylon stocking with a football inside of it from bleeding into the joint capsule.

I had similar prohibitions against putting any weight on it to those you are facing, and it was really tough to obey them. I became extremely adept at hopping on my left foot with my right foot drawn up. I hated the crutches.

My orthopedic surgeon said there was a very good chance my ankle would always be quite stiff, but everything was back to normal inside of 6 months, except that my tibia now covers the talus more than it did, reducing the range of motion of my ankle somewhat. Out of fear that my ankle would freeze up, I started flexing it inside the cast a month before I was supposed to move it at all.

I'd say you have a good chance of being able to get around OK by the time school rolls around in the fall. If you are less mobile than you'd like to be, it may give you a leg up on your homework, if anything.

My 'accident' happened on Easter day, and I deflected inquiries initially by claiming that "Christ rose and I fell", but too many people would just nod, as if to say 'Yes, this fits my estimate of your personality', and I had to fall back on just admitting my stupidity.

Given the number of bones you broke, I would like you to ask your orthopod to formally assess your bone density and strength.

Good luck!
posted by jamjam at 3:26 PM on May 29, 2010

That's a pretty bad injury. And everything your surgeon told you sounds valid assuming it is a true Lisfranc injury......and I'm also assuming you are seeing a specialized Foot and Ankle orthopod, yes? You will definitely need to be non-weight bearing for a full 10 weeks; please head that advice! Seriously - stay the heck off of it! As far as if it's possible to move during that time....well how many friends/family members do you have willing to help out?
posted by texas_blissful at 4:39 PM on May 29, 2010

**Oh jeez, "head" obviously means "heed"**
posted by texas_blissful at 4:41 PM on May 29, 2010

When I was in grad school, one of my colleagues broke her leg and the university's disabilities office assigned an undergrad (paid) to assist her as necessary. I'm reasonably sure that Columbia would have a similar office for accomodating students facing challenges like yours. Hopefully the Admissions office will refer you to them.
posted by sevenyearlurk at 7:55 PM on May 29, 2010

Try to get those nifty elbow crutches. My husband broke his hip a month or so ago and has been using them, and apparently they're way better than the underarm ones.
posted by leahwrenn at 8:21 PM on May 29, 2010

Yeah, I would ask the school about disability services. At my school, it's not just for permanently disabled people. We have assistants that help carry books, push wheelchairs, and drive you between buildings, class, and the metro stop. I'd look into that before deciding to defer.
posted by bluefly at 4:11 AM on May 30, 2010

Do whatever your doctor says. The only time I'd heard of Lisfranc injuries was in a column on football injuries. From what I understand, a Lisfranc injury for an NFL player is essentially career ending. IANAD, I just read about sports. Talk to your doctor. Follow all of his advice, and definitely talk to him about recovery/rehabilitation plans, and also about what you should expect going forward in regards to recovery. Ask him if you are going to be able to make a full recovery, and if so, what you need to do to make it.
posted by Ghidorah at 4:14 AM on May 30, 2010

A friend of mine did this last year, and I asked him to weigh in because of the similarities in injury:

"First, you need to lower your expectations. Things don't work out perfectly and you may need to be flexible and adjust your plans. Second, I had a Lisfranc fracture. It happened in August of 2009. This is not the kind of injury that is invisible. This will affect you for the rest of your life. Sometimes more, sometimes less. Make sure you understand that. It is now May 2010 and my foot still hurts me. I can walk. I haven't tried running as my foot is still weak. I had two screws permanently placed to hold the bones in place. I can tell when the weather is changing.

For the first three months, I sat in a recliner and essentially didn't move, except on crutches or a wheelchair. I could not drive as I injured my right foot. I preferred a wheelchair as crutches are much more difficult to move around in over larger distances. I was lucky and had a wife who brought me food and helped me into the shower/bath. You can get a sleeve that is watertight and pulls over your cast up to your thigh. This enables you to get into the bath/shower without getting your cast wet.

Your injury sounds worse than mine. IANAD, but you might be able to extrapolate a little based upon my situation. What you can do while laid up is to eat healthy. I actually lost about 15 pounds as my foot swelled so bad when I stood up that I never went to the cupboard looking for food. I literally sat in my chair almost 24 hours a day. I kept a backpack next to my chair and when I needed something to drink I'd use my crutches to get to kitchen, would put what I needed in the backpack, and then would crutch back to chair.

You must keep your foot elevated and you will need to sleep on your back to make that happen. I watched all the seasons of 'Deadliest Catch'. I highly recommend it. Once you get out of cast and into boot, you will need long white tube socks, otherwise the boot will chafe all the skin off your calf. Oh, and I simply missed a step on the stairs. Hope this helps. Cheers."
posted by pineapple at 10:01 AM on May 30, 2010

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