Dr. Oster:

I'm a 33yr old who suffered a Lisfranc fracture/dislocation on June 7, 2008 from a wakeboarding fall. I didn't realize that this was such a significant injury and have been having a difficult time coping with the surgical/rehabilitation process. I played soccer in college, and have managed to stay in shape, healthy and injury free throughout my life until now. After my injury I went to my general practioner and normal x-rays and a weight bearing x-ray were negative. After about a week and half of minimal improvement I went back to the doctor and got a CT scan and MRI which showed a (i) a 5mm lateral subluxation of the first metatarsal base relative to the medial cuneiform and (ii) a 2mm lateral subluxation of the second metatarsal base relative to the middle cuneiform. Also, the Lisfranc ligament was torn.

On July 7, 2008, a foot and ankle surgeon performed ORIF and put two 4.0 zimmer screws in my 1st and 2nd metatarsals. The surgeon then applied an external fixator to my first metatarsal which was removed one month post-op. The foot and ankle surgeon told me that everything looked good and that I needed to be non-weightbearing for 3 months total before beginning rehab/physical therapy. He also told me (i) that he did not want to EVER take the screws out unless they bothered me and (ii) that I should not play soccer or participate in certain other sports anymore due to risk of reinjury.

I was disturbed by this office visit and decided to see a different doctor who specializes in sports medicine. At that point I had been non-weightbearing for 10 weeks and the new physician immediately got me out of my cast, put me in a boot and started me on physical therapy and weightbearing as tolerable. I've now been doing therapy for 2 weeks and just went to a follow-up visit with the new physician. He wants to remove both the scews next week and insert an arthrex tightrope to add stability. I'm emailing to see if you agree with this approach. It seems that it is very controversial as to when (if ever) the screws should be removed. I want to get back to playing sports as soon as possible but at the same time I have already been sidelined for 3 months and dont want to risk reinjuring myself by being too agressive with treatment. The new doctor also told me that the procedure to remove screws and insert the tightrope is minimally invasive and that it would not set back my rehab/physical therapy. I guess the thought of having screws removed and something else put in my foot freaks me out a bit and i'm having trouble understanding how it is minimally invasive and won't impede my progress. Already I am walking in my boot with minimal pain and very little help from my crutches... Any thoughts that you may have would be very, very appreciated. Thank you.

Hi Carlos. Welcome.

I'm with doctor #2. The idea of fixation in a Lisfranc's reduction is that the fixation, when rigid, should only be used as a temporary means of reducing the injury. When the injury is healed (in terms of months) the fixation, which crosses a joint, should be removed.

The neat thing about the Arthrex Tightrope is that it's a dynamic means of reduction. I just did my first about 4 months ago. And your doctor is right, it's a minimally invasive technique and pretty darned easy to accomplish. Compared to rigid fixation, I think this is a great indication for the Tightrope.

So you're temped to just let it go? You know, I'd tend lean towards fixing it. I performed a midfoot fusion a few months back on a 45 y/o gal who had an untreated Lisfranc's dislocation in a high school football game. That was a big procedure. and if you could avoid that by having the Tightrope done, I'd go for it.

Jeff