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Lisfranc sprain

 
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wsurfn1426



Joined: 20 Mar 2004
Posts: 213

PostPosted: Tue Jan 02, 2018 3:35 pm    Post subject: Lisfranc sprain Reply with quote

I injured my left foot on a vulcan attempt in August. I suffered a Grade 1 Lisfranc sprain (evaluated by weight bearing plain films and a
MRI by a foot surgeon). I spent 6 weeks in a walking boot. I finally felt good enough to jog a mile, pain free, this past month (December). I have sailed B&J and 360s without pain in December. Finally, New Years Eve I started trying vulcans again, and I mildly re-injured it on a simple out the back crash on my second attempt. I have my straps pretty big. I was still able to sail afterwards, just the top of the foot is a little sore today.

I have a 25 year old medical degree, but my surgeon really does not know anything about windsurfing or windsurfers. He knows the injury association, but that's it. So, I think he really does not fully understand what we do/like to do. He also doesn't have a bunch of experience with patients like me.

I am looking to try to avoid surgery, as I can't afford the down time. At the same time, it is depressing to feel I am left forever to be sailing BAF or only oldschool freestyle ( although, I guess willy skippers are pretty cool).

Anybody out there in iW land fully recover from a non-surgical Lisfranc sprain? Is 4 months too soon to go for it? Any personal experiences with this injury? Smile

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AG80



Joined: 04 Mar 2014
Posts: 29

PostPosted: Tue Jan 02, 2018 5:56 pm    Post subject: Reply with quote

in general; Conservative treatment for Lis Franc sprain with 1-3 mm separation is non-weight bearing in CAM walker for 4 weeks followed by additional 8 weeks of wt bearing in a boot. Can be active out of the boot in a pool or on exercise bike.
Surgical treatment for separation of >5mm, 3-5 mm is often treated surgically in active individuals.
Grade I injury indicates minimal separation and 6-8 weeks in a boot would seem adequate for gradual return to physical activity, assuming physical therapy was started as soon as pain allowed. Of course, higher risk for re-injury and you may want to wait 4-6 months prior to returning to any activity which puts your foot at high risk for external rotation/eversion stress. Falling while windsurfing in the foot straps puts a similar stress on the foot as when falling with the foot in a saddle stirrup (the mechanism of injury for the early Lis Franc sprains)

Foot and toe sprains tend to seem minor, but in reality can be difficult to treat and be a source of chronic pain if not allowed to heal fully.

You are not doomed to sailing "forever BAF", but IMO you did return to attempting Vulcans too soon, especially if you were not doing PT.
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manuel



Joined: 08 Oct 2007
Posts: 793

PostPosted: Tue Jan 02, 2018 6:00 pm    Post subject: Reply with quote

That's a bit odd or unlucky or both!
Have many attempts do you have? It might be a matter of finding a way to fall in more safely?
Can your foot rotate in the strap enough?


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JamesHardy



Joined: 29 Mar 2002
Posts: 128

PostPosted: Tue Jan 02, 2018 8:31 pm    Post subject: Reply with quote

I have Lisfranc fractures in both feet, one done 15 plus and the other 10 years ago. I have had pain ever since, it just goes with being in a strap sport, the pain is a low dull ache most of the time I'm in the straps. But what am I going to do, stop sailing? Come on get real!
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wsurfn1426



Joined: 20 Mar 2004
Posts: 213

PostPosted: Tue Jan 02, 2018 9:13 pm    Post subject: Reply with quote

AG80, thanks for taking the time to respond. I assume you are a health professional in the orthopedic field.

New Years Eve was exactly 20 weeks post-injury. It took me a week to get seen by the foot surgeon and get fitted for my CAM boot. I wore it faithfully (reluctantly) the full 6 weeks. Just off to sleep and operate. I got a green light to windsurf for my 25th anniversary trip in Maui at the end of October, but we got completely skunked, and I did not get on the water the whole week. I sailed comfortably in the footstraps by November, but no way was I confident to try a vulcan or wave sail.

My foot surgeon is a great guy. He was recommend by a colleague, and has worked with the university athletes, and interestingly written a textbook on orthopedic rehabilitation that has been printed for years and has had multiple editions. Perhaps, it was assumed I knew, or the fact my insurance does not cover PT, but no formal rehabilitation regiment was prescribed. I did show him a GoPro video of the injury, so he had an idea of the mechanism and how I did it. You are correct it is eversion of the foot that causes the discomfort.

My understanding is the anatomic spacing can vary, and that is why the weight bearing x-rays are so important. My pre and post CAM boot period x-rays were stable, and I was ambulating pretty well at the end.

I guess I am just looking for some experienced guidance as to when I can go for it. I landed my first vulcan last February after years of trying, and I just want to get back at it. It is obvious in retrospect, 20 weeks was too soon for me. Now, I am unsure how much longer I should wait. I am happy to do any PT if it will help. I doubt windsurfing injuries are common in our area. I just am not sure if there is specific approach that would be best. Thanks again.
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alap



Joined: 17 Dec 2007
Posts: 122

PostPosted: Tue Jan 02, 2018 9:54 pm    Post subject: Reply with quote

what a fantastic 360 at 0:50..... phenomenal... zero loss of speed...
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isobars



Joined: 12 Dec 1999
Posts: 18692

PostPosted: Tue Jan 02, 2018 10:22 pm    Post subject: Reply with quote

I'd be doing ... er ... DID ... at least two things in your shoes ... er ... straps ... after destroying a knee:

1. Sail my butt off in the wildest conditions my local lake (the Gorge) could dish out all summer. Just one little concession: no straps. It was that or not sail, and I learned a great deal in the process, including that my highly maneuverable windSUP could handle twice the sail power its importer expected.

2. Did hundreds of hours of PT and obeyed every restriction he and my surgeon laid down. Once they trusted me to do the PT on my own (several hours a day just to get it ready for surgery and LOTS more afterwards) with occasional progress checks, I spent a LOT less time on my insurance clock.

I don't consider anything that I can do in a safer manner or avoid for a few months worth being permanently crippled for, as a Lisfranc injury can do. Some -- hell, MANY -- things are not worth getting crippled for. E.g., I refused one moderately effective cancer drug because of its high threat of permanently crippling side effects. I sure as HELL can't see some stunt being more important than walking normally for the next 40 years, but that's just me.
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Brian_S



Joined: 11 Jun 2005
Posts: 215
Location: SE Michigan

PostPosted: Thu Jan 04, 2018 9:19 am    Post subject: Reply with quote

I had a Lis Franc sprain two years ago on my left foot after getting it pinched at the mast base in a goofed up move. This ended the season for me in the fall and I wore the boot for six weeks, followed by a little PT. Since I live in Michigan, I had the winter to recover. I think it changed my shoe size by one half, but otherwise I'm pretty okay, or maybe lucky.
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merriam2



Joined: 25 Oct 2013
Posts: 24

PostPosted: Thu Jan 04, 2018 9:14 pm    Post subject: Reply with quote

AG80s advice is very good. I would only add that adequate support of the arch and positioning of the foot is essential during the healing period and beyond. Hopefully you have a very supportive foot orthotic or AFO to maintain good neutral alignment during healing otherwise the ligaments and bones will not heal in ideal position.
Don't rush it. Your body will likely heal itself if you don't stress it too soon.
I did have a lisfranc injury this July while windsurfing and treated it even more conservatively than AG80 advises. I think I am now about 90% of normal and expect full recovery for next season.
Tom
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wsurfn1426



Joined: 20 Mar 2004
Posts: 213

PostPosted: Thu Jan 04, 2018 11:32 pm    Post subject: Reply with quote

Thanks everyone. I am feeling much better every day. I know I am lucky and dodged a bullet.

If anyone can point me to PT resources for Lisfranc rehabilitation that would be great.

There is a little wind in the forecast for Sunday. Hopefully a little easy freeride test. Although it is going to be hard, I plan on shelving vulcan attempts again until spring.
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