This article is second in a series of seven 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
My June trip to Bend, Oregon was supposed to be about mountain biking, but my newly-diagnosed Lisfranc fracture took athletics off the table. What the trip became was an opportunity to get ready for the ordeal ahead.
The surgeon had laid out what the timeline would look like. 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 six weeks, then 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 this would involve. Looking near to far, I guess it looked something like this. 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 week-long, 200-mile backcountry mountain bike ride from Telluride, Colorado to Moab, Utah in early September.
What I needed was a plan.
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
“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.
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 writing down 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 jotted floor-based strength training exercises I thought I could add 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 make for excellent dynamic strength-training moves, so I also wrote down dips, one-leg-on-the-floor rows, pull-ups and pistol squats.
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 the saddle bags of my bike and was able to walk a hundred feet at a time in it. The night before, in fact, I took it to Mount Bachelor to take pictures and found hiking in the woods doable, if not easy. The device's remaining utility remained to be discovered.)
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 heavy comfort foods, ice cream and alcohol would be challenging to avoid. Last year I had a lot of success doing a diet that simply eliminated processed foods (“Keep it simple; Just eat real food” was the motto). 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 some of the extra fat from my middle.
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 200-mile bike ride. I’d ask my doctor about it again, but when I brought it up during my initial consultation she’d said, “That’s not definitely out of the question”—good enough for the time being. If she'd later give me the go-ahead, I’d start swimming and/or flat-water kayaking (maybe whitewater?) to try to incorporate other cardio exercise.
Finally, my detailed preparation also focused heavily on the longstanding goal of finishing a novel I’ve been working on for about 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 this project has 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 I went to work.
With so much of my summer committed to laying on furniture, I’d have lots of time to punch at the keyboard of my laptop and hatch new plot and subplot ideas. 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 do three things: 1) force me to read and clean up the first half of the book, 2) sink my head back into the story and 3) force me to 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.