Lisfranc injury

[banunishat]

I am 44 year old female with ALS for the past 1 year. Having right foot drop and last week had a very bad fall on the dropped foot. As the front part of the foot is loose, it got folded and fell down

MRI says lisfranc injury. The ortho surgeon recommend going for the surgery and fixing the lisfranc injury since if we don't do the surgery now, it may lead to future complications in case of other falls.

As there is foot drop, he is also offering to include a foot drop surgery to avoid future falls. It is not tendon transfer, rather it is a nail implanted to keep foot in place.

I am confused. Looking for your advice.

 

[lgelb]

Very sorry about your fall. As with any other proposed surgery at this stage, I would recommend a second ortho opinion from a second academic center (preferably an orthopod that doesn't do this type of surgery) and consultation with the physiatrist (physical med/rehab) specialist at your ALS clinic, or the neuro/PT if there's no PMR available at your clinic or the hospital it's associated with.

Factors to consider are what kind of mobility aid(s) you're using now, what rehab from this surgery entails, what your progression has been, etc.

 

[Nikki J]

Agree with Laurie. Re the nail for foot drop. A relative of mine had some kind of surgery to stabilize their ankle foot before they knew they had ALS ( issues were thought to be from a longstanding back issue). I think it helped for a short time though they said an immobile ankle/ foot made walking strange. Of course once they progressed to weakness higher up in that leg and the other it didn’t make much difference

 

[Bike Mike]

It’s hard to say whether or not the surgery is a good idea. Excellent idea to get a 2nd opinion and to talk to physiatrist at the ALS clinic. Since you are young and have been ambulating, it does seem like a good idea to have the surgery to fix the fracture. The thought of inserting a nail to assist with foot drop is not bad either. One of the main concerns you need to address is what the rehab and weight bearing restrictions will be after surgery. When will you be permitted to put full weight on the leg? If you will be in a cast or non-weight bearing for 8 weeks or more, that is a lot of time for muscle atrophy to occur, even without the ALS. Can your non-injured leg permit the mobility you need to function in the meantime, or will you need to use a wheelchair? Is there a non-surgical option, like wearing a brace (MAFO)? If you may need one anyway to address the foot drop, this option may permit you to continue with mobility without the downtime of surgery. The physiatrist should bring that perspective to help with your decision. Good luck!

 

[Farmerhoggett]

I have joined these forums because of my elderly father who was recently diagnosed. I can’t provide any advice on the nail. However, 7 years ago, I did had a lis franc fracture - needed 6 screws and 3 plates in my right foot. I had to be non-weight bearing for 12 weeks. Hope that info helps.

 

[banunishat]

Thank you all for replying. I have contacted my ALS clinic and they suggest to go with lisfranc surgery as it is necessary and no for the foot drop surgery. The surgery is completed and I am not weight bearing on the leg for 6 weeks. Thanks for the excellent support.

 

[Bike Mike]

Good luck with your recovery. Glad you’re moving forward now!

 

[dawnie24]

I had a Lisfranc injury before my ALS diagnosis. I opted not to have surgery. I was non weight bearing for 8 weeks then several week to get back to walking. My ortho said healing time would be the same with or without surgery, and it seems that was correct. I have no pain or problem in that foot, but drop foot in the other.