The 'Gap Sign'

During the whole period I had the cast on, my left foot hurt…and it hurt bad at times. When I went to go get my cast off I had little faith that my month long stint of cast life had improved the state of my injury. I told my doctor about my pain in the cast, and she recommended that I continue to wear a walking boot for another 4 weeks. I attempted to convey to her that walking around in a boot was going to do nothing for me. I wanted a more aggressive treatment. She offered an injection of Tormidal (NSAID) after 4 weeks if my foot did not feel better. I agreed and went on my way. Ironically, my foot hurt significantly more after the cast was taken off than before. 

The next three weeks were miserable, but the abnormal pains in my foot slowly began to recede. By week 3 though, my original injury still hurt. I scheduled a doctors appointment and got the injection into my joint. The injection was very painful and did not guarantee anything. I left the doctors hoping that the injection would relieve the pain at least till I could figure out my next step. Fortunately, after seeing that all possible conservative measurements failed at helping my foot, my doctor referred me to a foot and ankle surgeon. Finally! But of course I had to wait 3 weeks till the next available appointment. I waited and in the mean time the injection proved to subdue the pain in my foot somewhat. When the day came to go to my appointment I was so anxious that I was trembling. To make sure I provided a good case, I brought photo comparisons of the left and right feet along with a journal article about the ‘Gap sign’ <The gap sign> (signals a Lisfranc injury). At the surgeon’s office, I first talked with the doctor and told him my story. I then got a few weight-bearing x-rays. The doctor analyzed my past x-rays, MRI’s, and bone scan along with the new x-rays. He explained some key features he noticed in the imagery and then said he believed my tarso-metatarsal joint complex was unstable due to injury to ligaments between the bones in that area. Specifically, he told me the weight bearing x-rays showed a slight gap between my first and medial cuneiform. This was a tell tail sign of some variation of a Lisfranc injury. His words were like music to my ears. What he said to me was what I had been preaching to all the other doctors. I told him everything that I had been thinking about my foot: gap between my big toe, clicking and popping, and feeling of instability whenever I walked. He listened and agreed with most everything I said. Even going as far as corroborating my story with the x-rays and MRI. At that point, he told me that he suggested surgery as a viable option to fix my foot. Surgery is by no means something I was excited about, but I knew from the very beginning it was the only way to save my foot. I talked with the doctor about my options and I went ahead and scheduled surgery 4 weeks out.

I left the surgeons office pumped full of adrenaline. I couldn’t believe that a doctor finally gave me the diagnosis I had been saying all along. After some careful consideration and more research, I decided to get a second opinion. I was commended to a surgeon by a fourth orthopedist (yes fourth) that I saw. The visit with the second opinion went even better than the first. Not only did he clearly see that I had some variation of a Lisfranc injury, but he also was one of the leading surgeons in that area of research. He gave me his tentative plan for surgery and possible recovery outcome, and then without hesitation I scheduled surgery with him for 4 weeks out. Of course I called my first surgeon to let him know of my choice. He was in no way bothered or offended. The four weeks leading up to my surgery date were uneventful as far as my left foot pain goes. It wouldn’t be fun or interesting if my right foot didn’t start to act up though, right? Well that’s what happened. I was able to keep my right foot under control enough to go ahead with surgery as planned, and hat is where I am now.