Setting goals for Lisfranc recovery gives optimism
This article is second in a series that chronicles my experience following Lisfranc injury.
Part 1: Learning about the scary life-altering potential of a Lisfranc fracture
Part 2: Setting goals for Lisfranc recovery gives optimism, determination and purpose
Part 3: Surgery day and learning about the Arthrex InternalBrace
Part 4: Lisfranc recovery is slower and tougher than imagined
Part 5: Relearning to walk and ride a bike after Lisfranc surgery
Part 6: The 215-mile Lisfranc recovery test
Part 7: Looking back a year later. What’s fixed and what isn’t.
Part 8: Did the iWalk crutch speed my recovery?
With a newly-diagnosed Lisfranc fracture to nurse, my June trip to Bend, Oregon became an opportunity to plan for the ordeal ahead.
The surgeon had laid out the recovery timeline:
After the operation, I’d go for a week in a cast before switching to a walking boot for the duration of the recovery.
I’d put zero weight on my right foot for four to six weeks.
Then I’d spend the ensuing four weeks gradually putting increasing amounts of weight on my foot in the walking boot.
By August 31, if things went well, I’d be able to walk under my own power without a cumbersome walking boot.
I injured my foot June 2; I’d be ready to walk unassisted by August 31.
There was a huge array of challenges ahead. I’d be on strong pain killers for a week and out of work for a couple weeks. I’d be unable to do high-intensity-training classes, ride a bike or walk very far for two months. I’d experience muscle atrophy, gain weight and be depressed. And I might miss a big adventure vacation we had planned for the fall: a week-long, 200-mile mountain bike ride from Telluride, Colorado to Moab, Utah.
What I needed was a plan.
Setting clear goals can help on your Lisfranc recovery journey
While my wife and friends went mountain biking in the mountains above Bend, I crutched my way to a couch on the front porch of our rented house and got to work.
I wrote a list of objectives.
Healing via rest, stretching, appropriate strength training
Healing via smart diet; maintain and/or lose weight
Make the Telluride-to-Moab mountain bike ride
Western Perspective photography project as possible
Business planning as possible
The view from the front porch of our rented house in Bend. This is where my Lisfranc recovery planning started.
“This is a big setback,” I wrote, “but it’s also an opportunity to reprioritize. I want to be healthy and make the ride in September, but being forced to sit down is a chance to do sit-down things. For one, I’ll be doing sit-down exercises and stretching, but I can also dust off the 80,000 words worth of novel that still isn’t done, a longstanding photography project and various schemes about being my own boss.”
In order to recover in time for the 200-mile, 20,000 vertical foot backcountry mountain bike ride, I’d need to be creative. Recovery times for Lisfranc fractures are long, and I’d be inactive in my traditional ways. That left diet and non-traditional exercises, and some critical thought about how to deal with the inevitable weakness of my lower right leg, which would go almost completely unused for three entire months. It might not be possible to join the ride at all.
Establish a doable workout to avoid as much muscle atrophy as possible
First things first, though. I needed to figure out how to maintain as much muscle mass and flexibility as possible for the parts of my body that weren’t directly affected by the injury.
I started by developing a workout I thought I could manage in the first week or so after the surgery. It mostly consisted of stretching I could do while sitting, laying down or positioned on my hands and knees. I then added floor-based strength training exercises I thought I could do as the pain in my foot began to ebb: one-leg push-ups, leg raises, kneeling leg extensions and seated rubber band rows.
I didn’t think I’d be ready right away, but I have a set of rings in the garage that are excellent for dynamic strength-training moves, so I also wrote down dips, one-leg-on-the-floor rows, pull-ups and pistol squats.
Hiking with the iWalk, I managed to get to the water's edge for this nice late-day photograph of the South Sister. I didn't realize at the time just how much utility (and boosted mental health) the iWalk would add to my recovery.
Finally, thinking about the innovative crutch someone lent me, a piece of equipment called an iWalk, I listed rubber band and dumbbell exercises I could do while standing in the iWalk: military presses, band pull-aparts, arm curls and upright rows.
(The iWalk itself had a lot of potential. I'd already figured out how to put it in my bicycle saddle bags and was able to walk a hundred feet at a time in it. The night before I took it to Mount Bachelor to take photographs and found hiking in the woods doable, if not easy. The device's remaining utility remained to be discovered.)
Establish a healthy diet to give your body the nutrients it needs for recovery
Satisfied I’d found an exercise to hit every part of my body, I focused next on diet. I knew I’d have to fight a recovery-long depression and almost-total shutdown of endorphins that would impact my activity level and diet. The quick fixes like comfort foods and alcohol would be challenging to avoid.
The previous year I’d experienced success on a diet that simply eliminated processed foods (“Keep it simple; Just eat real food” was the tagline). With that in mind I wrote a quick diet plan focusing on low carbs, no/low alcohol, high protein and high vegetable content. If I could get in the mindset of a diet challenge, I might be able to avoid weight gain—and might even be able to shed a few pounds.
Physically, that was about all I could do during the first four to six weeks to maintain some level of conditioning and prepare for the September bike ride, which my surgeon had said was “not definitely out of the question.”
Setting a big project goal is a great way to focus on the positive during recovery
Finally, my detailed preparation also focused on the longstanding goal of finishing a novel (check out the finished novel here) I’d been working on for two years. I set August 31, the day I’d be released from the confines of my walking boot, as the deadline. Most of my work on the project had happened during cold, dark winter mornings when I was able to curl up with a steaming coffee and hammer at the keys in the dark before going to work.
With so much of my summer committed to laying on furniture, I’d have the time hatch new plot and subplot ideas and make the prose flow more naturally. In order to force the work to happen, I committed to my wife that I’d give her the first half of the book within a few weeks after surgery. That might not seem like a big deal, but after two years she still hadn’t read any of it, so the goal would force me to read and clean up the first half of the book and accept feedback from my most valued tough-love adviser.
When the mountain biking crew got back from their three-hour ride, they found me on the floor in the living room with my workout bands going through the various exercises I wrote down for my summer strength-training workouts. I wasn’t excited about missing the day’s mountain bike ride, or the rest of the summer’s hiking, biking, running, boating, swimming and camping activities. But I was energized by having goals to meet, a plan to execute, and creativity and determination to apply to get there.
Disclaimer: I am not a medical or mental health professional. I'm not even current on my CPR or first aid certifications. Do not substitute any information found here for a visit with a knowledgeable doctor, preferably one who specializes in foot and ankle problems.