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Sunday, May 18, 2008

Part Two: My Right Foot

The saga continues…

I was surprised that it was my foot – I had been truly convinced that I had just sprained my ankle. I was thinking that I would surely miss some days of work and probably need crutches for a week or so. I could wiggle all my toes (albeit with excruciating pain). Certainly my foot was not broken. The doctor ordered me to X-Ray.

I was whisked away and a painful series of pictures was taken of my foot, which now resembled a fat shiny balloon. A nurse rolled me back into ER and where, I called Jason and gave him directions to the hospital – nearly 50 minutes from home. Someone put an ice bag on my foot. I waited. I called my parents and a few friends to let them know the situation. I waited some more. I called the garage where my car was towed to so see where in the heck it was. Jason called to make sure he was going the right direction. I flagged down a nurse and frantically tried to verify where the hospital was – even though I work there, I’d not yet had cause to visit the ER. Eventually and I think somewhat miraculously Jason arrived, and very soon after the ER doc returned with a diagnosis.

I did, in fact, fracture my foot. The third metatarsal, to be precise. The ER doc, however, said this was really a minor issue – he suspected I might have a much bigger problem, called a lisfranc fracture. This is basically an injury, such as a facture or ligament tear, in the bones of the midfoot. This is what Wikipedia (http://en.wikipedia.org/wiki/Lisfranc_fracture) had to say about the origin of the name:

The fracture was first described by the French doctor and surgeon Jacques Lisfranc de St. Martin, who worked in Napoleon's army. This type of injury, which Lisfranc first described, occurred when a horseman fell while riding, having trapped his foot in the stirrup or fell into a drain. At present, such an injury happens typically when one steps into a hole and the foot twists heavily. Falling from a height of two or three stories can also cause this fracture. American football players occasionally get this injury, often when they have their foot pointing down and someone lands on their heel.

And here’s a scientific explanation from http://orthoinfo.aaos.org/main.cfm :

Lisfranc injuries occur at the midfoot, where a cluster of small bones forms an arch on top of the foot between the ankle and the toes. From this cluster, five long bones (metatarsals) extend to the toes. The second metatarsal also extends down into the row of small bones and acts as a stabilizing force. The bones are held in place by connective tissues (ligaments) that stretch both across and down the foot. However, there is no connective tissue holding the first metatarsal to the second metatarsal. A twisting fall can break or shift (dislocate) these bones out of place.

See, that part about no connective tissue? Those words are key. A metatarsal is the toe bone, with your first metatarsal being your big toe bone. So, basically, there is nothing but soft tissue connecting your big toe and second toe -- no muscle, no bones -- all the way up to where your foot joins your ankle. In my accident, my right foot pressed the brake all the way down to the floor, with all my weight behind it. During the collision, the brake was forced backward against my foot. If, as the doctor suspected, there was more damage than a broken toe, it would not show up on an X-Ray since X-Rays show bones and some muscles clearly and none of these connect the first and second toe. If these bones had been displaced in the accident, he suggested, I may need a CAT scan or MRI to assess the full damage.

I was a bit concerned, but the ER doc said that there was no certainty that I had this kind of injury, but I really should see a specialist like a orthopedic surgeon or even podiatrist to rule it out. For the time being, I received crutches, a prescription for pain meds, an ace bandage, and a little orthopedic boot. I was instructed to put no weight on my injury, to elevate it, and to ice it as much as possible. By this time it was nearly 8pm. My accident occurred, I think, at about 3:30.

Jason drove me back to Santa Cruz, where we filled my prescription and then went home where I actually fell asleep despite the pain and discomfort. I felt lucky to be alive, and really wasn’t processing the extent of my injury of what it would involve as far as work, where the semester still had five weeks to go before graduation and summer vacation. I didn’t know what was in store as far as recovery, or even the true extent of my injury. I would need to follow the labyrinthine instructions of my health insurance provider, and first go to my General Care provider so I could be referred to a specialist.

Tune in later to find out what the specialist says…

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