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KosAbility is a community diary series posted at 5 PM ET every Sunday and Wednesday by volunteer diarists. This is a gathering place for people who are living with disabilities, who love someone with a disability, or who want to know more about the issues surrounding this topic.  There are two parts to each diary.  First, a volunteer diarist will offer their specific knowledge and insight about a topic they know intimately. Then, readers are invited to comment on what they've read and/or ask general questions about disabilities share something they've learned, tell bad jokes, post photos, or rage about the unfairness of their situation. Our only rule is to be kind; trolls will be spayed or neutered.

These are my feet. They aren't the kind of feet that get to model on TV. But they are my feet, and they are pretty damn useful.

feetsitting

It doesn't look too odd. In a sock and shoe, it looks just like everyone else's.
Until you see me walking barefoot.
feetstanding

Why do I stand like that? Because of damage to my Lisfrancs joints in my right foot.
Illustration 4 from www.aafp.org/afp/980700ap/burrough.html

The Lisfrancs joints are the joints where the metatarsals of the foot meet the tarsal bones of the ankle. They are the solid foundation of the longitudinal arch of the foot. Unfortunately, since there's just one ligament maintaining the alignment, the joint can be disrupted. And because the arch is a vital component in the human stride, having an injury to the Lisfrancs joints is disabling.

The incidence of Lisfranc joint fracture­ dislocations is one case per 55,000 persons each year.Thus, these injuries account for fewer than 1 percent of all fractures.As many as 20 percent of Lisfranc joint injuries are missed on initial anteroposterior and oblique radiographs.  link

It's very subtle even on an X ray. Here's some films to prove the point. Look back and forth between the right and left feet to see it. On this one, the left foot is the injured one.

Illustration 2 from www.aafp.org/afp/980700ap/burrough.html

How does it happen? In my case, I stepped too hard on a brake pedal, and did this...

Illustration 5 from www.aafp.org/afp/980700ap/burrough.html

Typically a Lisfranc injury occurs when there is a severe twisting force on the joints connecting the forefoot and midfoot. The forefoot is stuck in place and the force occurs through the athlete’s entire body when all their weight twists around the fixed forefoot. This classically occurs when a horseman falls off a horse and their foot stays locked in the stirrups. This same mechanism of injury can occur during a windsurfing accident. The windsurfer’s foot remains in the board’s stirrup while the surfer falls off the board. These injuries more commonly occurs when someone’s forefoot is stuck in the turf or ground and they unexpectedly rotate when making a cut, changing directions or are being tackled. This last type of injury is influenced by the friction between the playing surface and the athlete’s shoewear.

Another mechanism by which a Lisfranc injury occurs is when an athlete, typically an offensive lineman in football, sustains a direct blow compression injury through their foot. The lineman is blocking an opposing defender while moving forward such that only their forefoot is on the ground while their heel is raised in the air. If another player falls on the blocker’s heel, a significantly large axial force occurs through the lineman’s Lisfranc joint. Furthermore, if any twisting motion also occurs, the injury can be more severe. link

These are usually treated surgically. Mine was too. So I had a screw put in, with wires through the skin to hold everything in place. It healed. But like a lot of people who have the injury, I developed arthritis in the joint afterwards. It may need fusion to manage the pain. Because it hurts. It has hurt since I was 25. I will be 40 this winter. My life was never the same again.

I found out I never can wear heels again. My foot has spread; I now wear a wide instead of a regular. Since I wear a ten in women's anyway, I normally just get a man's athletic shoe. Even dress shoes are required to have a lot of orthopedic support. I don't wear anything most people might define as a dress shoe these days.

I cannot do anything that keeps me on my feet for long periods of time. Long periods of time are defined as ten minutes or more. If I do it anyway, I'll pay.

I now refer to myself as having a "standing budget". It's affected by how much I spent yesterday, and the weather, but I have learned over time about how much I have. If I don't do anything else standing up that day, I can do the grocery shopping. On a good day, I can walk a half-mile, but I won't be able to walk any more than that, and I'll be sore the next day or two. Doing the dishes is hard. I can wash a sinkful, and sit down for thirty minutes. I can wash another sinkful, and sit down again. Assuming it's a good day.  Carrying any extra weight, whether a basket of laundry or a case of sodas, will amplify the pain and shorten the time I can be on my feet. My back doesn't like the motion of sweeping and mopping, and that makes housework that much more difficult.

But they aren't all good days. Approaching weather fronts often dictate whether or not I have all my standing budget that day, and like many people with chronic pain, I often borrow from tomorrow to make today look normal, and deal with being sore where no one but my husband will see me. On bad days, I find myself not drinking so much because I have to walk to the bathroom. I find myself going without meals because I would have to walk to the kitchen and stand while I made even a simple sandwich, and it's just too sore for that.

Sore. It's such a small word. Drop a concrete block on your arch and drive a railroad spike through it, and you get a feeling for it. It's an odd sensation of chaotic unhappiness that reaches up about mid-calf.  Generally the torn ankle ligaments like to join the pain party, too. Of course. At that point, I can't stand to wear a sock, let alone a shoe, and I'm lucky to be able to get to and from the bathroom. I try very hard not to let it get to that point.

There are some add-on effects. Stand wrong, and it affects your knees, your hips, your back. Since the injury, I have been fighting muscle contractures in my calf and thigh and hip. It is a constant battle to stretch it out, to keep it working. I sleep in a brace every night. When I let it go, I get plantar fasciitis and my back begins to develop lumbar scoliosis. The plantar fasciitis is only annoying, it's not near the hurt that the foot is, but the back gets just as bad, so I keep working against the tide. I manage the pain with Tramadol and with Skelaxin for the spasms. I can't take Vicodin due to the side effects, and I like the fact that Tramadol has an SNRI component that lets me think about how to manage the pain without panic. It works well for me.

When will I get more treatment for it? Who knows? We have no income, and no insurance, and the orthopedic surgeon requires $180 in cash to go. And like many people, I can always think of someone who needs it more; my husband's knees need replacing, his shoulder needs attention, there is always the utility bills, and I have a terrible weakness for a new nail polish color for my toes.

But I am one of the people who parks in the handicap spots and walks apparently fine into the store. If you watch you may see a slight limp. That's all. That's enough.

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