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Old 10-15-2008, 02:52 PM   #1
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Lightbulb My lisfranc injury story (right foot ligamentis dislocation 7mm)

Hello,
I wanted to put together my story of lisfranc joint injury in one post and keep it updated as I go along.
The lisfranc injury requires a very long recovery period, through out this time I had learned a lot, through the internet, this web site, books, doctors and friends. I wanted to share my story and what I have learned.
If you search for my handle you will find a number of posts, but most of them only show a part of the story.


Each lisfranc's injury is different, the treatment plan can vary widely based on each individual doctors take on, what is still a controversial, procedure for a rare injury.

Things to consider when looking at my treatment plan, I was active in sports, I have injured my foot windsurfing, during winter months I used to teach snowboarding. I was looking for a doctor with experience in treating athletes with a similar injury. I needed my foot back in working order to get back to teaching sports. I was told that screws have to come out or there is a good chance I am going to break them during one of the snowboarding jumps. I was also given an option to get a mini tightrope. This is a new device on the lisfranc's market, available since last year (2007) that supposed to prevent re-injury, there is not enough data on the effectiveness of the device as of yet.
If you have a ligamentis lisfrancs (your ligaments are torn) they will not grow back, the way your body fixes itself is with scar tissue. I used BioSil to speed up scar tissue generation, do not know how effective it has been, but my nails grow 3 times as fast

Here is my story:

5/31/2008
I was windsurfing on a small lake in Wisconsin, with my feet in straps. I have been windsurfing for 15 years and the day was pretty relaxing with flat water and light gusts. I was racing with my friend and when another gust rolled through I felt very sharp pain in my ankle. It was almost like I had a nail driven through my foot, considering there were nail in the water I figured I might have pinched a nerve and kept on going for another 10 feet. The pain was not going away, it was getting more intense if anything. I let the rig go and fell into the water, the pain was getting to unbearable levels, I suspended my injured foot into the water and waved for help. I felt my foot swelling up and decided to remove the windsurfing booty before the foot is too large and while it is numb from the cold water. That was a good decision. With the foot out and me eventually out of the water I was picked up by my wife. She also had a large beg of ice ready for me, I was able to freeze my foot to a completely numb state and with the help of some alive the pain was subdued to a manageable level.
I waited a day before showing up at the doctors office.
The pain was no longer intense, yet the foot was very swollen, the ankle was looking ok, but the foot - was twice the size and blue was showing on top and bottom of my foot, I have not seen an injury like that before. At this point I had a slight inkling that I might need to see a doctor, this one did not look like something I can just walk off.

Lessons learned:
lisfranc joint damage is a suspect when your foot swells up and blue shows up on the bottom of the foot.
Jumping on one foot to get around is dangerous, get crutches asap


6/2
I went to see a doctor (OS) at Bannokburn office, he took a number of x-rays, a couple of them were load bearing (painful), the diagnosis was that I had a lisfranc sprain with no dislocation and a couple of bone chips. Conservative treatment plan was recommended, meaning - I stay in a hard cast for 8 weeks. At this appointment a fracture I had sustained in my ankle was missed. I was put in a dark blue cast and sent home with a pair of crutches. I was told to show up in 2 weeks for a check up.

Lessons learned:
with foot injuries get a second opinion, always
although it is tempting to think that surgery can be avoided for lisfranc injuries, it is better to face the reality as soon as possible. There are countries in the world that do not do open reductions for lisfranc dislocations, but use different fixation techniques, like setting the bones manually under x-ray and securing them in place with external application of a cast, that gets re-applied when swelling gets down (every 2-3 days). Unfortunately this approach as a low success ratio.
If you are going with a surgery, know that your future walking ability depends on how soon you get the surgery done, post-traumatic arthritis sets in quicker if you wait longer.


6/16
I am back from a follow up, the cast is taken off. By then the swelling is way down and foot is only about 1.5 times the size of the other, blue spots are around toes, but it looks like I am on my way to a speedy recovery. Minimal pain, mostly located around my ankle (remember that missed fracture?), the foot hurts little under pressure exerted during examination. More x-rays are taken, weight bearing x-ray shows separation of 2mm.
I am being asked if I stepped on my foot at all since the cast was put on, I say of course not, as a matter of fact I kept it up all the time to help with the swelling. I was told to wiggle my toes to speed up healing and that was the only thing I did.
I asked about the pain in the ankle, another set of x-rays later I was told I have fractured a bone in my ankle as well.
I am being told that I will need a surgery to fix the lisfranc, my dreams of speedy recovery are crushed, I call on my friends and relatives to find a doctor who would have a different take on the injury, I hope to avoid the surgical intervention at any cost.
I solicit second opinions from as many doctors I can, but getting appointments on such a short notice is almost impossible and the doctors I do get to talk to all tell me that this is very tricky procedure and they do not have enough experience with it to do it well.
In mean while I learn that the sooner I get the surgery the better my chances are going to be. The doctors offering non-surgical treatment give me no guarantees about the results of the treatment, that is not encouraging.
By the time the end of the week rolls around I am totally exhausted, my pregnant wife and my parents are falling of their feet after running from one doc's office to another. My hands are shaky my sides are bruised from crutches. Finally we talk to a doctor who tells us that he has done plenty of the lisfranc surgeries and can do mine as well. But his schedule is booked for next 3 month.
We get on a waiting list.
The x-rays at this appointment showed separation of more than 7mm, looking at my bones floating around my foot cleared any doubts I had about fixing this surgically.

Lessons learned:
If you are diagnosed or suspect lisfranc injury, seek second opinion and just in case get on the surgery list, if you decide not to pursue surgery, you can always cancel the appointment.
If the foot does not hurt much, it does not mean you will be able to walk on it.


6/20
I am called in for a surgery, they had an opening, the only minus the hospital is out-of-network for my insurance. I went for it any way.
I was exhausted, hurting and tired, stressed out of my mind coming in to the hospital. The first IV I got was to calm me down, from there on I just did not care, the drug induced Haze surrounded the procedure. I was given a block followed by general anesthesia.
The last thing I remember was inhaling the gas and when I exhaled I was back in the waiting area. Given 2 vicaden and told to start taking painkillers regularly. And so I did, double dose of Norco 2 hours later, the pain hit about 3 hours post surgery, it was brutal, with anything to take my mind off the pain and counting minutes to the next does of norco, it was hell. The minutes crawled the pain was unbearable, at some point I started talking about going to hospital to get pain control going. But I managed to live through it. More Norco and more. It is hard to remember everything that happened, I had my parents keep watch over me changing ice every half hour on my foot to keep swelling down day and night. Everyone was beat down in three days following the surgery. Even when the pain is under control getting a normal sleep is hard, keeping the foot elevated 24 hours a day is tough on your back and uncomfortable to sleep. But keeping foot up, higher then you heart level, will reduce swelling and assists healing.

Lessons learned:
start Painkillers asap
getting off the painkillers will be an adventure, arrange a weaker prescription ahead of time to get you off the strong stuff
have your relatives and friends lined up, you will need a lot of help
think ahead about getting to the bathroom, it will not be simple, you might want to get a porta-poty and pee-cup ahead of time.
pain eventually goes away, although it does feel like you just pass out from it. Be tough, it will be over.
Have food prepared and stored ahead of time, recover after the surgery can take a long time.


7/18
I am back at the doc's office, the hard cast is taken off and replaced with a walking boot, but no walking is allowed.
In the month preceding this welcomed change, I was in bed, with my foot up. Pain was managed with norco and later with darvocet, pretty successfully over all. I could only get 2 hour long periods of sleep through out this time, turning was a wake up and do it process. My physical condition has deteriorated, the affected leg became a match stick, my overall muscle tone was very low, I lost a lot of strength a lot more the I thought is possible.
I had hard time rolling out of the bed and making it to the bathroom. Each step was a full blown adventure. I could not keep my foot down for more then 5 seconds! make it 2 seconds, I was training it to stay down every day, so the 5 second down was an achievement. I also tried to move my injured foot to keep the muscles alive, but just did not have the strength to do enough of the exercises to make a visible difference.
Please keep in mind that I planned on exercising my upper body and even wrote out the exercises for my abs and legs to do post-op, I developed a list based on the movement restriction (having one leg raised at all times and no sharp movements), but very little reps could be done.
Instead of the exercise I used a device called air-o-sage, a as seen on TV product, that is past its fame, it is composed of inflatable cuffs that you can put on your legs, cuffs inflate to apply gentle pressure and help with circulation.
Using this device made a considerable difference in my healthy leg.

Here is the exercises I planed to do:
(while on my back)
abs crunches (keep my legs up and lift upper body)
with my back on the bed, straight leg lifts
followed by bicycle with my legs while on my back
then
flip slowly on to my stomach and do the leg lifts one at a time to work the hamstrings and butt.
finish the routine off with push ups (keep your legs bent at the knees with feet up).

Lessons learned:
air-massage works
get of the painkillers asap, addiction sets in fast
you will get weak, very weak, be ready.
eat well, eat fiber
exercise as much as you can
if it is painful to keep your foot down for more then a couple of seconds, you can train the foot by lowering it for short period of a time.
keep the foot up ALL of the time (unless you are training)
watch movies, read, get on internet, post your story


7/21
I am in for physical therapy, the best day so far.
The physical therapist, Jennifer, set the goals explains the process and generally instills hope. Finally I see a light at the end of the tunnel.
First day is all about pain. I am told to take a painkiller before coming to PT next time.
It is hard to see what is left of my foot out of the cast.
The exercises are about regaining flexibility in my toes and ankle, a lot of cricking and popping noises coming from the foot, scary.
I am to continue with PT twice a week until the surgery to remove the screws in November.

Lessons learned:
PT makes a world of difference, you will have someone who has seen this injury before and knows what you can and cannot do. Someone to guide you through every movement and someone you can ask a lot of questions that doctors appointment just is not long enough for.
You will get a do-at-home exercises, attend to them religiously.
Your therapist is your partner in the healing, if you do not feel comfortable with the one you have, look around.

<<<< UPDATE>>>>
Since I left of the log in July, I continued going to PT 3 times a week, eventually supplementing the PT exercises with time in the pool. I bought xerosock, a rubber sock you can put over your cast that is completely air tight and does not let water in. I was not permitted to swim and kick with my legs in the pool, but it helped a lot getting out of the house and bed and into the water.
By beginning of September I was able to keep my foot down for about an hour and used that time to go to the gym and work on machines, granted I was VERY weak and could only do about 10 minutes of a work out at first. But I persevered and that 10 minutes slowly grew into an hour of exercise a day.
By the time October 23rd (screw removal) rolled around, I was in a lot better physical and mental shape. The right leg remained a noodle and was shaking with any sort of load, but my left side started to firm up. But the greatest benefit of regular exercise came from a better mental state. I was no longer getting depressed, I could see the progress I was making, although very insignificant but it was positive progress. After spending months upon months watching my body painfully deteriorate, I was finally able to slow that process down (and the reversal was at hand).


October 23rd 2008

Let's get the hardware out.
The idea of hardware removal, as it was explained to me, was to get me back into sports, leaving screws in exposed me to screw breakage (I am a snowboard instructor, besides windsurfing and would like to go back to doing jumps one day).
So the screws had to come out.
Going into the surgery, I had no pain at rest, no pain standing or waling in the CAM boot. Through PT I regained full range of motion and was basically pain free.
Remembering quite well the horrors of post op, I lined up family and friends, got an ice machine, stock up on movies and pain killers.
The hardware removal is a MUCH easier surgery to live through, but taken on its own it is still pretty bad.
I was given sedative and was out for the duration of the procedure, I came out ok and immediately started on the full does of oral painkillers (no half doses like the last time), I remained in semi-conscious state for next 2 days. While my family administered the ice and I elevated my foot.
After 2 days I went off the pain killers and felt pretty good about it, considering there was nothing standing between me and my foot, no cast this time, I was able to observe the results of the surgery. Stitches in the same place like after the first surgery, foot swollen, no discoloration.

Oct 27 2008
PT resumes
With my stitches still in I was ordered to show up for PT, that is 4 days post surgery. Needless to say I could not keep my foot down for a reasonable amount of time, but I got check over by PT and started on exercise.

My PT regiment consisted of 3 PT sessions a week augmented with 2 accupancture sessions, I wanted to control the pain without medication.

I continued this rigorous approach to recovery until December 3rd, when I saw my surgeon post op. I was told that I have developed pretty severe case of osteopenia, my bone density was very low. This was caused by me being NWB for such a long time and partial weight exercises in PT just were not enough to stop bone depletion.
My doctor sent me to the pool PT, when you get into a shallow pool and perform walking and other motions, thus getting closer to 100% WB.
From my second pool appointment I developed pretty severe pain in the joins and eventually in the mid foot.
The pain became so severe that I would collapse into the pool not able to step on my right foot. I was advised by the doctors office to keep putting the weight on the foot or I will suffer bone fractures that will jeopardize the recovery, so with the help of accupancture I ventured on.
I was able to increase my WB time to about 3-4 hours a day in tremendous pain, but I knew I had to do it.

The foot showed some continuous bruising that would turn brighter after each PT session and then turn yellowish at the edges next day.

Finally I went to see my doctor for a follow up, February 4 2009.
The good news was that osteopenia has slowed and I was out of the danger zone (woo-hoo). The not-so-good news was that the pain I feel is from arthritis in my mid foot, I also have edema in most of my joints due to load during PT.
I was ordered to take it easy and control the arthritis with pain medication.

This is where I find myself today (2/11/09):
I cannot make a single pain-free step, because of arthritis and edema, I cannot even simply stand without pain.
There is a good chance edema will dissipate with time, but a very painful arthritis is here to say. I am at the loss on what to do from this point on. I am still moving around with crutches or a cane, putting full weight on the foot is just too much pain, I can stumble around by using my heel, but this is no way to live.

Feel free to post questions I will try to answer as much as I can.

I also would like to thank every one who has replied to my messages on this board, supported me and helped me along.

Last edited by dawindsurfer; 02-11-2009 at 02:17 PM. Reason: update

 
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Old 10-18-2008, 09:58 PM   #2
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Re: My lisfranc injury story (right foot ligamentis dislocation 7mm)

Surfer - good to hear that you're getting better.

I, like you, was determined not not allow the rest of my body to deteriorate while my foot healed. Even while still NWB, and before I was cleared to start PT, I was in the weightroom at the Y. I was only able to use the cybex (and similar) machines - no free weights. I found that I could workout my full upper body and do some leg/hip exercises, but not hamstrings - it caused me to flex my foot = pain. I would take off my boot in order to do leg extension for my quads. I was still on crutches, and it took quite a bit longer to finish my workout, but it helped me get back to competition much quicker.

I also had my screws removed, about 4 months after the original surgery, due to one of them starting to back itself out. I was back on the court and playing ball about 3-4 weeks after the surgery to remove the hardware.

Good luck, and continued recovery! You'll be boarding this winter!

 
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Old 10-19-2008, 07:16 PM   #3
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Re: My lisfranc injury story (right foot ligamentis dislocation 7mm)

Surfer & R Ball,

I was so happy to find you both! I stopped looking online regarding recovery of this injury because it was too depressing. I even looked for Pro athletes... and many disappeared after their injury, or the severity of the initial injury was not disclosed.

I will post my full story tomorrow when I'll be sitting on my toosh alone all day... but for now the short story is :

9/7/08: Gal takes me out in soccer game, all force into my foot

9/8 : minor emergency says no fracture, "call us if it doesnt get better"

10/3: go to Foot OS PA, so he can tell me what's wrong b/c I want to start running.... "Lisfranc,... you need surgery ASAP"

10/09: surgery, 2 pins to stablize 2nd TMT joint

I read the Med articles and they have the statements... "% got back to previous activities..." but WHAT were their previous activities?? of the 40 patients how many play soccer or run??? Soccer is a HUGE part of my active life AND social life and family life.... and I haven't done my Iron Man yet... not to mention my brand new Garmin GPS Forerunner that has only been used once....

Well, you get my frustrations... I'll elaborate later. And again thank you. Especially you R Ball Player... you are the first I have found that continues to post after a GOOD recovery. Because of you my optomistic/realistic goals for my recovery has risen.

THANK YOU

 
Old 10-23-2008, 01:20 AM   #4
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Re: My lisfranc injury story (right foot ligamentis dislocation 7mm)

Its always nice to see stories in regards to lisfranc injuries. I suffered mine lisfranc injury on june 18th of 2008.. long story short.. I slipped on some uneven ground next to a pool and had my right foot fall in the pool while the left foot stayed on the deck. My left foot was the foot that suffered the injury.

Since I didnt have insurance, I went to the nearest hospital I could which was Hollywood Presbyterian. ER doctor told me I had a fracture and referred me to a doctor in the Koreatown district of Los Angeles. I followed up on the referral 3 days later.. and the doctor mis-diagnosed the injury as a fracture.

2 days after the first referral, I went to my friend's father to seek advice. Told me the best bet was LA County/USC Medical. Went to the general hospital and told them about the diagnosis. After approximately a 3 hour wait, I was diagnosed with a lisfranc injury by the trauma resident. I was then admitted over night, because of the delay and backlog in surgery referrals due to overcrowding. 33 hours later after sharing a room with 5 other patients in the ortho 3rd floor, I had my referral.

Came back a week later for surgery. Had three screws inserted and were told them they were permanent. Was advised non weight bearing for 3 months in good ol plaster cast. Was able to wear a boot after 3 months and advised by an ortho resident that "most people dont need physical therapy and learn how to walk on their own."

4 weeks later.. i have weened (forced?) my self off the boot and have been walking with nikes a half size larger than my previous shoe size. Saw the doctor today and again and told " everything should be alright. expect limited ability. good chance to not be able to regain full spectrum of previous activities (e.g. basketball, soccer)."

For those with previous lisfranc injuries.. are there major harms in leaving the screws in permanently? what are my chances of performing physical contact sports after such an injury, compounded with the lack of insurance-based medical care?

thanks for any responses. its been crazy not having insurance. i never see the same doctor twice... just a carousel of ortho and trauma residents. my advice for any lisfranc sufferers is have insurance!!!!!!!

 
Old 10-30-2008, 09:35 PM   #5
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Re: My lisfranc injury story (right foot ligamentis dislocation 7mm)

Hello,

I had my Lisfrabc surgery on August 15, 2008. I had a bone graft(hip) and placed in my foot, betwenn the 1st and 2nd met, weith two screws. Two weeks agot I went to the doctor to have my cas removed; however, after I took 1 step forward, the pain was (damn). The docotor put the cast back on and said, " see you in month." That will be three months in a cast before I start rehab. I guess 47 years old has its disadvantages. Anyway, I hope I have a full recovery, although I will most likely lose some mobility.

 
Old 02-12-2009, 07:44 AM   #6
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dawindsurfer HB User
Re: My lisfranc injury story (right foot ligamentis dislocation 7mm)

How are you doing now days? Did the cast come off? Are you able to make the first steps?

I have updated my original post with new information, not much progress to report, unfortunately

 
Old 02-13-2009, 06:48 PM   #7
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Re: My lisfranc injury story (right foot ligamentis dislocation 7mm)

I can empathize about the arthritis developing in your foot. I hear that is quite common for lisfranc injuries. I often walk in pain when it is cold. I have not required using a cane or crutch in the past 3 months, but I continue to walk with a significant limp due to pain. I'm not close to running at all.. but I have started riding an exercise bike. Since I don't have insurance, I was never really offered physical therapy by the hospital. However, I got a new job and the insurance will kick in next month. I would love to hear a real, professional ortho doctor to examine the huge lump of what seems to be scar tissue that constantly throbs and aches. Also, the student doctors seemed to have all decided that I should leave my screws in. As I read in your post, screws are taken out especially when the said patient wants to perform actively in athletic sports. My screws are still in my foot and I wonder what the risks are of them breaking within the foot. One student doctor said that if there were no significant risks if the screws broke in my foot due to activity.

Hang in there.. and I hope things begin to progress more. When the insurance kick in, I look forward to utilizing physical therapy since that was a previous option I did not have. Furthermore, since the October visit, my doctor's appointments have ended and have received no further follow up. I can definitely understand the frustrations that come along with this injury, especially if you used to be active pre-lisfranc. But these winter months could be difficult months for lisfranc sufferers and the warm weather of the summer might help. I live in southern california and have noticed that on rainy days (when there are actually rainy days) my foot hurts more then on warm, dry days. Once again, I hope your battle with the injury progresses on a positive note and the pain will subside!!!

 
Old 07-10-2009, 06:45 PM   #8
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Re: My lisfranc injury story (right foot ligamentis dislocation 7mm)

Hey guys I might aswell join the club.

In May of this year I suffered a fall from a 2 storey height. My right foot took most of the impact. Long story short I went in for surgery 2 weeks later.

Apparently I dislocated all my metatarsals by 4mm, and had a fracture dislocation of the Lisfranc complex, with bony fragments/fractures of the 2nd metatarsal and all cuneiforms.

I had 3 screws put in the 1st and 2nd metatarsals to secure them together and to the cuneiforms. The other metatarsals had removable k-wires. I got the wires out last week, and put into a supportive boot, and have been told to partially weight bear. It is now only 6 weeks since the surgery and I find I can take the boot off and walk around in a regular shoe, only putting weight on my heel and with quite a bit of pain. I want to get back to full movement as soon as possible but perhaps I'm being a bit optimistic. Maybe I should put the boot back on lol!

I'm in the UK and was lucky enough to get an NHS surgeon who really seems to know what he's doing. The metatarsals were reduced to exactly where they should be, so a full recovery is possible. Tho having scoured the internet reading stories of other people's Lisfranc experiences has left me depressed to say the least.

Of course, as luck would have it my job involves walking around all day and in my spare time I like to jump off cliffs on skis, so a disabling foot injury is really the last thing I want or need.

I'll keep updating here with stories of my road to a full recovery! (Fingers crossed)

 
Old 07-13-2009, 08:37 AM   #9
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Lisfranc after high fall

Blimey, it all sounds so complicated. And indeed, the more research I do the more important details I find. One thing that I find odd is just how serious the injury sounds when reading about it on the internet, compared to how little information I've been given by the hospitals on after care and potential complications. What they've been telling me is that yes, there's a risk of arthritis (but nothing on how to avoid it or even delay the onset) and that the foot may hurt a bit after walking a long distance.

As yet I've had no advice on what exercises to do or how much weight I should be putting on the foot. Last week at the hospital, I asked how long it would be until I would be able to walk unaided. The reply was 'hmmm.... a couple of weeks'. Somehow, I don't think that's quite likely.

It's hard to tell if the pain in the foot is due to muscle atrophy and weak ligaments from not walking for so long, or whether it's because of the injured bones and ligaments not being healed yet. I'm expecting physiotherapy to be painful when I get it, but I'd feel a lot more motivated if I knew I wasn't just doing more damage.

I've read stories (I think there's one on here) about people pushing themselves to walk on a lisfranc injury after only a few weeks, and consequently making a full recovery. This approach has been effective for myself with previous injuries; I've had quite a few broken bones and torn ligaments. If it wasn't for what I've read on the internet, I'd be doing that right now, but in this case I'm not sure it's the best idea (tho it may be).

The rareness of this injury puts anyone with it in a tricky position, not really knowing exactly what advice to follow, and I'm sure its different for everyone anyway. On the one hand I'm tempted to listen to my body and just do what I can, slowly pushing through the pain barrier. On the other, I don't want to have to walk with a cane for the rest of my life. Having said that, I've been looking at some antique canes and some of them are rather nice

I've been doing a lot of weight lifting too, and have changed my diet completely to only whole foods, lean meats, fruit and vegetables and no junk food at all. It can only help.

I'm hoping the internet is heavily biased towards those who have suffered long term, and this would seem to make sense. For every 20 people suffering from pain after 5 years, there's most probably 20 others who have made a full recovery, and forgotten about it. Those still suffering will be far more likely to be discussing it online. I sure hope I'm not reading this post again in 2014

It's back to the hospital again on Wednesday, I think I'm gonna see if I can have the screws removed in a few months. Fingers crossed.

 
Old 08-27-2009, 10:21 PM   #10
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Re: My lisfranc injury story (right foot ligamentis dislocation 7mm)

I NEED INPUT AND ADVICE!!!

I am trying to make a decision as to whether or not I should have surgery on my lisfranc fracture dislocation.

Injury took place July 24, 2009. A fracture of the 4 metatarsal was diagnosed, but the lisfranc dislocation was missed. I was put in a plaster cast on July 28th. I had no weight baring until August 12th (18 days after injury). I then began walking on my cast with slight pain for 24 hours. After that I have had no pain, just what feels like muscle tenderness.

My hard cast was removed August 25th (32 days after injury). The weight bearing X-rays revealed a lisfranc dislocation with the 1st and 2nd metatarsal and whatever. The dislocation is considered slight at 3mm. The bone fracture has totally and completely healed. Surgery is recommended for the dislocation, but prognosis of outcome is questionable because of the length of time that has passed since the injury. It will be 6 1/2 weeks since the injury by the time I have the surgery. A CT scan of the foot has not been done.

I am hesitant to do the surgery because I have no real pain, just slight surface tenderness where the little bit of swelling remains. I still have the blue patch on the bottom of my foot which is indicative of a lisfranc injury. I am fearful of creating more harm then I already have. Plus I have an 8 month old and I am a stay-at-home mom and I am having a hard time seperating that complication from my decision. Hence I am looking for advice.

I'm not incredibly athletic, but I was looking forward to getting back to my moderate jogging and snow skiing again someday when the kids get old enough.

Any advice would be helpful.

Thanks

 
Old 08-31-2009, 04:45 AM   #11
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Re: My lisfranc injury story (right foot ligamentis dislocation 7mm)

Have the surgery done!!! I experienced the same thing. I went 3 months after the non weight bearing cast and Physical therapy only to discover that I had to have surgery and go through the whole thing again!!
In my experience, you will never be the same again after the Lisfranc dislocation. But the surgery does work better than not having it at all. I have to wear good lace-up shoes that help support the foot, since I no longer have an arch. But it is better than before the surgery.

Just get a GOOD doctor to do it. Call your major hospitals and ask for an experienced Othepedic doctor. I had mine done at a teaching hospital and was used as a learning experience for the training doctors. Lisfranc is not that common and they use us to help others learn. Good luck to you.

 
Old 09-01-2009, 01:47 PM   #12
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Re: My lisfranc injury story (right foot ligamentis dislocation 7mm)

[QUOTE=dawindsurfer;3762405]Hello,
I wanted to put together my story of lisfranc joint injury in one post and keep it updated as I go along.
The lisfranc injury requires a very long recovery period, through out this time I had learned a lot, through the internet, this web site, books, doctors and friends. I wanted to share my story and what I have learned.
If you search for my handle you will find a number of posts, but most of them only show a part of the story.


Each lisfranc's injury is different, the treatment plan can vary widely based on each individual doctors take on, what is still a controversial, procedure for a rare injury.

Things to consider when looking at my treatment plan, I was active in sports, I have injured my foot windsurfing, during winter months I used to teach snowboarding. I was looking for a doctor with experience in treating athletes with a similar injury. I needed my foot back in working order to get back to teaching sports. I was told that screws have to come out or there is a good chance I am going to break them during one of the snowboarding jumps. I was also given an option to get a mini tightrope. This is a new device on the lisfranc's market, available since last year (2007) that supposed to prevent re-injury, there is not enough data on the effectiveness of the device as of yet.
If you have a ligamentis lisfrancs (your ligaments are torn) they will not grow back, the way your body fixes itself is with scar tissue. I used BioSil to speed up scar tissue generation, do not know how effective it has been, but my nails grow 3 times as fast

Here is my story:

5/31/2008
I was windsurfing on a small lake in Wisconsin, with my feet in straps. I have been windsurfing for 15 years and the day was pretty relaxing with flat water and light gusts. I was racing with my friend and when another gust rolled through I felt very sharp pain in my ankle. It was almost like I had a nail driven through my foot, considering there were nail in the water I figured I might have pinched a nerve and kept on going for another 10 feet. The pain was not going away, it was getting more intense if anything. I let the rig go and fell into the water, the pain was getting to unbearable levels, I suspended my injured foot into the water and waved for help. I felt my foot swelling up and decided to remove the windsurfing booty before the foot is too large and while it is numb from the cold water. That was a good decision. With the foot out and me eventually out of the water I was picked up by my wife. She also had a large beg of ice ready for me, I was able to freeze my foot to a completely numb state and with the help of some alive the pain was subdued to a manageable level.
I waited a day before showing up at the doctors office.
The pain was no longer intense, yet the foot was very swollen, the ankle was looking ok, but the foot - was twice the size and blue was showing on top and bottom of my foot, I have not seen an injury like that before. At this point I had a slight inkling that I might need to see a doctor, this one did not look like something I can just walk off.

Lessons learned:
lisfranc joint damage is a suspect when your foot swells up and blue shows up on the bottom of the foot.
Jumping on one foot to get around is dangerous, get crutches asap


6/2
I went to see a doctor (OS) at Bannokburn office, he took a number of x-rays, a couple of them were load bearing (painful), the diagnosis was that I had a lisfranc sprain with no dislocation and a couple of bone chips. Conservative treatment plan was recommended, meaning - I stay in a hard cast for 8 weeks. At this appointment a fracture I had sustained in my ankle was missed. I was put in a dark blue cast and sent home with a pair of crutches. I was told to show up in 2 weeks for a check up.

Lessons learned:
with foot injuries get a second opinion, always
although it is tempting to think that surgery can be avoided for lisfranc injuries, it is better to face the reality as soon as possible. There are countries in the world that do not do open reductions for lisfranc dislocations, but use different fixation techniques, like setting the bones manually under x-ray and securing them in place with external application of a cast, that gets re-applied when swelling gets down (every 2-3 days). Unfortunately this approach as a low success ratio.
If you are going with a surgery, know that your future walking ability depends on how soon you get the surgery done, post-traumatic arthritis sets in quicker if you wait longer.


6/16
I am back from a follow up, the cast is taken off. By then the swelling is way down and foot is only about 1.5 times the size of the other, blue spots are around toes, but it looks like I am on my way to a speedy recovery. Minimal pain, mostly located around my ankle (remember that missed fracture?), the foot hurts little under pressure exerted during examination. More x-rays are taken, weight bearing x-ray shows separation of 2mm.
I am being asked if I stepped on my foot at all since the cast was put on, I say of course not, as a matter of fact I kept it up all the time to help with the swelling. I was told to wiggle my toes to speed up healing and that was the only thing I did.
I asked about the pain in the ankle, another set of x-rays later I was told I have fractured a bone in my ankle as well.
I am being told that I will need a surgery to fix the lisfranc, my dreams of speedy recovery are crushed, I call on my friends and relatives to find a doctor who would have a different take on the injury, I hope to avoid the surgical intervention at any cost.
I solicit second opinions from as many doctors I can, but getting appointments on such a short notice is almost impossible and the doctors I do get to talk to all tell me that this is very tricky procedure and they do not have enough experience with it to do it well.
In mean while I learn that the sooner I get the surgery the better my chances are going to be. The doctors offering non-surgical treatment give me no guarantees about the results of the treatment, that is not encouraging.
By the time the end of the week rolls around I am totally exhausted, my pregnant wife and my parents are falling of their feet after running from one doc's office to another. My hands are shaky my sides are bruised from crutches. Finally we talk to a doctor who tells us that he has done plenty of the lisfranc surgeries and can do mine as well. But his schedule is booked for next 3 month.
We get on a waiting list.
The x-rays at this appointment showed separation of more than 7mm, looking at my bones floating around my foot cleared any doubts I had about fixing this surgically.

Lessons learned:
If you are diagnosed or suspect lisfranc injury, seek second opinion and just in case get on the surgery list, if you decide not to pursue surgery, you can always cancel the appointment.
If the foot does not hurt much, it does not mean you will be able to walk on it.


6/20
I am called in for a surgery, they had an opening, the only minus the hospital is out-of-network for my insurance. I went for it any way.
I was exhausted, hurting and tired, stressed out of my mind coming in to the hospital. The first IV I got was to calm me down, from there on I just did not care, the drug induced Haze surrounded the procedure. I was given a block followed by general anesthesia.
The last thing I remember was inhaling the gas and when I exhaled I was back in the waiting area. Given 2 vicaden and told to start taking painkillers regularly. And so I did, double dose of Norco 2 hours later, the pain hit about 3 hours post surgery, it was brutal, with anything to take my mind off the pain and counting minutes to the next does of norco, it was hell. The minutes crawled the pain was unbearable, at some point I started talking about going to hospital to get pain control going. But I managed to live through it. More Norco and more. It is hard to remember everything that happened, I had my parents keep watch over me changing ice every half hour on my foot to keep swelling down day and night. Everyone was beat down in three days following the surgery. Even when the pain is under control getting a normal sleep is hard, keeping the foot elevated 24 hours a day is tough on your back and uncomfortable to sleep. But keeping foot up, higher then you heart level, will reduce swelling and assists healing.

Lessons learned:
start Painkillers asap
getting off the painkillers will be an adventure, arrange a weaker prescription ahead of time to get you off the strong stuff
have your relatives and friends lined up, you will need a lot of help
think ahead about getting to the bathroom, it will not be simple, you might want to get a porta-poty and pee-cup ahead of time.
pain eventually goes away, although it does feel like you just pass out from it. Be tough, it will be over.
Have food prepared and stored ahead of time, recover after the surgery can take a long time.


7/18
I am back at the doc's office, the hard cast is taken off and replaced with a walking boot, but no walking is allowed.
In the month preceding this welcomed change, I was in bed, with my foot up. Pain was managed with norco and later with darvocet, pretty successfully over all. I could only get 2 hour long periods of sleep through out this time, turning was a wake up and do it process. My physical condition has deteriorated, the affected leg became a match stick, my overall muscle tone was very low, I lost a lot of strength a lot more the I thought is possible.
I had hard time rolling out of the bed and making it to the bathroom. Each step was a full blown adventure. I could not keep my foot down for more then 5 seconds! make it 2 seconds, I was training it to stay down every day, so the 5 second down was an achievement. I also tried to move my injured foot to keep the muscles alive, but just did not have the strength to do enough of the exercises to make a visible difference.
Please keep in mind that I planned on exercising my upper body and even wrote out the exercises for my abs and legs to do post-op, I developed a list based on the movement restriction (having one leg raised at all times and no sharp movements), but very little reps could be done.
Instead of the exercise I used a device called air-o-sage, a as seen on TV product, that is past its fame, it is composed of inflatable cuffs that you can put on your legs, cuffs inflate to apply gentle pressure and help with circulation.
Using this device made a considerable difference in my healthy leg.

Here is the exercises I planed to do:
(while on my back)
abs crunches (keep my legs up and lift upper body)
with my back on the bed, straight leg lifts
followed by bicycle with my legs while on my back
then
flip slowly on to my stomach and do the leg lifts one at a time to work the hamstrings and butt.
finish the routine off with push ups (keep your legs bent at the knees with feet up).

Lessons learned:
air-massage works
get of the painkillers asap, addiction sets in fast
you will get weak, very weak, be ready.
eat well, eat fiber
exercise as much as you can
if it is painful to keep your foot down for more then a couple of seconds, you can train the foot by lowering it for short period of a time.
keep the foot up ALL of the time (unless you are training)
watch movies, read, get on internet, post your story


7/21
I am in for physical therapy, the best day so far.
The physical therapist, Jennifer, set the goals explains the process and generally instills hope. Finally I see a light at the end of the tunnel.
First day is all about pain. I am told to take a painkiller before coming to PT next time.
It is hard to see what is left of my foot out of the cast.
The exercises are about regaining flexibility in my toes and ankle, a lot of cricking and popping noises coming from the foot, scary.
I am to continue with PT twice a week until the surgery to remove the screws in November.

Lessons learned:
PT makes a world of difference, you will have someone who has seen this injury before and knows what you can and cannot do. Someone to guide you through every movement and someone you can ask a lot of questions that doctors appointment just is not long enough for.
You will get a do-at-home exercises, attend to them religiously.
Your therapist is your partner in the healing, if you do not feel comfortable with the one you have, look around.

<<<< UPDATE>>>>
Since I left of the log in July, I continued going to PT 3 times a week, eventually supplementing the PT exercises with time in the pool. I bought xerosock, a rubber sock you can put over your cast that is completely air tight and does not let water in. I was not permitted to swim and kick with my legs in the pool, but it helped a lot getting out of the house and bed and into the water.
By beginning of September I was able to keep my foot down for about an hour and used that time to go to the gym and work on machines, granted I was VERY weak and could only do about 10 minutes of a work out at first. But I persevered and that 10 minutes slowly grew into an hour of exercise a day.
By the time October 23rd (screw removal) rolled around, I was in a lot better physical and mental shape. The right leg remained a noodle and was shaking with any sort of load, but my left side started to firm up. But the greatest benefit of regular exercise came from a better mental state. I was no longer getting depressed, I could see the progress I was making, although very insignificant but it was positive progress. After spending months upon months watching my body painfully deteriorate, I was finally able to slow that process down (and the reversal was at hand).


October 23rd 2008

Let's get the hardware out.
The idea of hardware removal, as it was explained to me, was to get me back into sports, leaving screws in exposed me to screw breakage (I am a snowboard instructor, besides windsurfing and would like to go back to doing jumps one day).
So the screws had to come out.
Going into the surgery, I had no pain at rest, no pain standing or waling in the CAM boot. Through PT I regained full range of motion and was basically pain free.
Remembering quite well the horrors of post op, I lined up family and friends, got an ice machine, stock up on movies and pain killers.
The hardware removal is a MUCH easier surgery to live through, but taken on its own it is still pretty bad.
I was given sedative and was out for the duration of the procedure, I came out ok and immediately started on the full does of oral painkillers (no half doses like the last time), I remained in semi-conscious state for next 2 days. While my family administered the ice and I elevated my foot.
After 2 days I went off the pain killers and felt pretty good about it, considering there was nothing standing between me and my foot, no cast this time, I was able to observe the results of the surgery. Stitches in the same place like after the first surgery, foot swollen, no discoloration.

Oct 27 2008
PT resumes
With my stitches still in I was ordered to show up for PT, that is 4 days post surgery. Needless to say I could not keep my foot down for a reasonable amount of time, but I got check over by PT and started on exercise.

My PT regiment consisted of 3 PT sessions a week augmented with 2 accupancture sessions, I wanted to control the pain without medication.

I continued this rigorous approach to recovery until December 3rd, when I saw my surgeon post op. I was told that I have developed pretty severe case of osteopenia, my bone density was very low. This was caused by me being NWB for such a long time and partial weight exercises in PT just were not enough to stop bone depletion.
My doctor sent me to the pool PT, when you get into a shallow pool and perform walking and other motions, thus getting closer to 100% WB.
From my second pool appointment I developed pretty severe pain in the joins and eventually in the mid foot.
The pain became so severe that I would collapse into the pool not able to step on my right foot. I was advised by the doctors office to keep putting the weight on the foot or I will suffer bone fractures that will jeopardize the recovery, so with the help of accupancture I ventured on.
I was able to increase my WB time to about 3-4 hours a day in tremendous pain, but I knew I had to do it.

The foot showed some continuous bruising that would turn brighter after each PT session and then turn yellowish at the edges next day.

Finally I went to see my doctor for a follow up, February 4 2009.
The good news was that osteopenia has slowed and I was out of the danger zone (woo-hoo). The not-so-good news was that the pain I feel is from arthritis in my mid foot, I also have edema in most of my joints due to load during PT.
I was ordered to take it easy and control the arthritis with pain medication.

This is where I find myself today (2/11/09):
I cannot make a single pain-free step, because of arthritis and edema, I cannot even simply stand without pain.
There is a good chance edema will dissipate with time, but a very painful arthritis is here to say. I am at the loss on what to do from this point on. I am still moving around with crutches or a cane, putting full weight on the foot is just too much pain, I can stumble around by using my heel, but this is no way to live.

Feel free to post questions I will try to answer as much as I can.

I also would like to thank every one who has replied to my messages on this board, supported me and helped me along.[/QUOTE]
ok - I guess it's a come to reality day. After finally looking up what lisfranc breaks are ... it's doesnt look great. I know it's only been 6 wks but I am going nuts. I go back in 3 wks to remove screws/pins, and put some weight down. I guess I just thought I would start walking...but from what I have read all day that's not going to be the case. I just finished my first triathlon a month prior to my accidnet. My goal was to do a half ironman later this year and a full next year. Should I hang up my dreams or just post pone for a few years? ( HOW are you today?

 
Old 09-07-2009, 09:31 PM   #13
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Re: My lisfranc injury story (right foot ligamentis dislocation 7mm)

Ok, here's my story. I am 55 years old.

In my line of work, sometimes I have to climb up on the roofs of buildings to install, and maintain communications antennas. On July 22, this was my first time on the roof of this building.There were two different levels of the roof, one was about 4 feet lower than the other. On both levels, there was white highly reflective cover, when in combination of a bright sunny day, made it real hard for me to see. I needed to get down to the lower level, but the conditions made it very difficult to properly judge how far down the lower level was. In short, I stepped off the ledge thinking it was about 1 1/2 feet instead of 4.

I came down on my right foot, and although I had felt sharper, more intense pain from banging my shin or stubbing my toe, this was a type of pain that I never felt before. My co-worker (not knowing how bad I was hurt, and admittedly, neither did I) helped me to my feet, and I'm hobbling around on it, waiting for the pain to subside, thinking it's nothing but a bad sprain and such. I limped back to the side of the building, and climbed back down a 30 foot ladder, hobbled about 50 feel to my truck, and drove 70 miles back home. But I'm noticing a searing pain each time I pressed on the accelerator or the brake. (Thank God I didn't have to slam on the brake) I called the wife and told her that was going to the ER before I came home. As luck would have it, the hospital's ER was a construction zone. So I had to drive around and hobble through the main entrance. I just fell in through the front doors, the pain was excruciating. Someone helped me into a wheelchair and rolled me to the ER, where they took X-rays. They found the 2nd metatarsal fractured, but they suspected more damage and referred me to an ortho-surgeon the following day. They sent me home in a boot, with no compression bandage to keep down the swelling.

Since I was injured on the job, I had to jump through the Workman's Comp hoops, and it took me two days to get to see an ortho. They told me to get a CT scan and bring both the films and the radiologist's report right back. Curiosity got the the better of me and I read it while my wife was driving me back to the doctor.

I almost had to roll down the window and throw up.

It said I had a "Divergent Lisfranc fracture-dislocation". The base of my 2nd metatarsal (the longest bone of the arch, or mid-foot) was "comminuted", meaning shattered into many pieces. In addition, there were "avulsion fractures" of the cuneiform and cuboid bones, meaning that ligaments have torn away, taking pieces of bone with them.

The first ortho (referred by my Workman's Comp) didn't cheer me up. He was holding up a foot model and showing me where he was going to "fire a pin" here, and "fire a pin" there, in order to stablize the foot. But he says, "I want you to be aware that you're going to have a bad foot regardless. You're probably are going to feel pain from here on out. How much, will remain to be determined. But this is a very serious injury, a very high energy type of injury that I see from auto-accident victims, parachute jumpers, falling thru ceilings, etc. Don't rule out the possibilty that you'll walk with a limp after I've done all I can do. If the pain gets too unbearable, I might have to do a bone fusion. But right now, I have to get in there and try to reduce the amount of arthritis that will set in." But he says, "it will be a couple of weeks before I can operate until the swelling comes down." But they sent me home without my foot wrapped, and didn't tell me to put my foot up or anything.

Well, something didn't feel right about this ortho, so I called a family friend who is a physician and explained what this ortho wanted to do. He investigated and came back and said that for my injury, I needed a foot and ankle specialist, not someone who just 'dabbles' in it, while doing knee reconstructions and shoulder replacements.

He referred me to a foot/ankle doc who he said specializes in Lisfranc injuries. I got an appointment with him on the day two weeks after the injury. He said he needed a new CT scan because the previous one ordered by the original doc didn't have the all the views, but that he couldn't do surgery anyway because my foot was swollen up like a balloon. He sent me home and told me to come back a week later, and this time they [B]finally[/B] wrapped my foot up and told me to keep my foot higher than my heart, and ice it down to bring down the swelling. I go back a week later, and he saw that the swelling had come down enough for him to do surgery the following week.

So, 4 weeks after the injury, I undergo surgery. He put in a plate with 4 screws to line back up the 1st metatarsal. He found the base of the 2nd metatarsal blown into little 'chicklets'. He extracts them all and mixes them together with 2 bone grafts that he takes out of my heel, and packs it into the area where the 2nd metatarsal base used to be. He installs a second plate with 5 more screws, and along with 3 more long screws laterally to create a "scaffold" for the new bone to grow. He then fused the entire Lisfranc joint between the 2 plates. Thank God they put a nerve block behind my knee!

I went back last Thursday (two weeks post-op) to get that splint off and the stitches removed. That's when he showed me those post-op medieval looking x-rays. Most of the pain, except for pretty bad twinging, has gone away, but I still need Vicodin to sleep. They put on a new fiberglass cast, and told me to keep my foot up in air for the next 4 weeks. Whenever I have to get up and hobble to the bathroom on my crutches, or go out to the kitchen to get a drink of water, my foot instantly inflates like a balloon like someone's using a bicycle pump, and turns deep purple. I'll feel a lot better mentally when it stops doing that.

I'll keep posting as it seems from reading others' stories, that this is going to be one long journey.

Last edited by Marcus1953; 09-07-2009 at 09:37 PM.

 
Old 09-23-2009, 03:54 PM   #14
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Smile Re: My lisfranc injury story (right foot ligamentis dislocation 7mm)

I'll update. What I didnt include in my story is that I had a little fertilized egg headed to attach to my uterus when I had my first Lis Franc surgery to insert the 2 screws in my foot. I only ruptured... actually, my actual LisFranc ligament pulled a sliver of my bone off my base of the 2nd metatarsal.

I was Non-weight bearing for 8wks.
Went straight to walking in running shoes. This was also the start of my second trimester in pregnancy.
5 months post op, had screws removed
6 month post, was ok'd to do PT and get back to previous activities... however I got a bad respiratory cold that lasted 3 weeks and I was 7 month prego.
8 months post op, had a C-section (to further delay getting back...)
9 months post op, 5 wks post c-section started walking for exercise...slowly adding stretches of running, 20 yards at a time, working up to a mile...

It was very painful, but more so in my joints, muscles (lack there of) Took 5-7 weeks for the pain to subside, and now it mainly is just in my foot at times. I can run 3.5 miles now, and do so almost every other day. (PT wont let me go further/faster nor more often) Sometimes my foot is sore other times its not. While other times I'll suddenly have sharp pains.

PT, (which I started at 11months) is worried about my long term. Surgeons say there are no guarantees wether I "baby" my foot or not.

Basically, I change my philosophy continually... Do I "use it tell I loose it?", or save it in hopes that it will delay problems. My fear is that I wont run, play soccer, do my Ironman 2011... And I will still have problems 10-15++ years from now. What if I can play + run.... and I'm not much worse in 10-15 years... or I get in a car accident, loose a leg???

If you cant tell. I'm leaning towards the "use it, until I loose it" philosophy. Why bike and swim only, when there is no guarantee it will help in the long term. They havent done this surgery long enough to know the outcomes... despite the small number who get Lisfranc, then considering to what degree severity it is, if they're an athlete or not.... Get my drift. I am going to do what I enjoy now, because there really isnt any guarantees I'll even be here later.

(But dont get me wrong... I am not going to be stupid... I am going to PT, and I will not overdo it with my foot... )

Sorry such a long wordy, thing... dont have much time with a baby around again (my other daughters are 9 & 12)

Good luck everyone.

 
Old 09-26-2009, 06:11 PM   #15
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Abby Lim HB User
Re: My lisfranc injury story (right foot ligamentis dislocation 7mm)

Hi all, as my daughter and me sufer from some kind of foot problem, we discover this forum and great to note that we can learn and share our experience here, I am not that serious as I supposed to be, going to try the Bonvolent compressed sock found found from this forum and will report if it help in my condition.

 
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