The E-Mail . . . Ugh

This is the e-mail I received from Coach Fritz yesterday which explains my current injury status from the view point of the doctors and athletic training staff....

Coach Fritz,

I understand that we have not seen good improvement in Jacquelyne’s foot than what we hoped before. However, Lisfranc injury is not simple injury to deal with. As we had discussion before, although recovery time for this injury is somewhat controversial, it involves a great deal of time and it typically takes years to recover from injury. Although surgery helps stabilizing joint, it is very difficult to deal with pain after injury and is arduous to get back to pain free. We have hoped for Jacquelyne to return to throw somewhere between 6 and 12 months after surgery which is fairly reasonable figure if recovery went well. Although her foot alignment on x-ray is good and there are no abnormalities on recent MRI after surgery, at this point, I am very aware of she has only very little improvement in terms of pain. This obviously delays her return to throw plan. It has been 7 months and 2 weeks since she had first surgery in May 19, 2011. We scheduled her surgery as soon as possible after 2011 Outdoor Big 12 because we knew recovery from this injury and surgery takes long time. I have hoped that she could start doing more functional activity in February which is 9 months after surgery because it is reasonable figure if recovery went well. This means that she should have some improvement by now. However, she is still experiencing pain with fairly light and easy weight bearing rehab as well as normal daily activities such as walking. I am aware of this is big delay for return. We tried injection and this seemed not working well. As you know, we recently underwent hardware removal in November 4, 2011, which is 2 weeks ago. Jacquelyne stated that knot which is place end of wire which stabilizing joint was causing friction and she thought it was giving pain on her medial side of foot. This surgery went well, but she has not felt big change in pain yet. Dr. Palmgren agrees that she can try more functional activities such as turning for throwing, but he wants her to ease back into functional activities in 4-6weeks. This is why he wants to have her back in his office in December 20, 2011. As you know, Dr. Palmgren talked about fusing joint if there is no improvement and Jacquelyne still experiencing high magnitude of pain. Fusing lisfranc joint will be last option for this injury and we hope this solves pain, but it may cause some side effects such as osteoarthritis later in her life. Dr. Palmgren, Jacquelyne, her dad and I discussed about this. Recovery time after this surgery is very similar to the one she had; none weight bearing and boot for 6 weeks and we are still looking for somewhere between 6 and 12 months for return to throw.

Answering your questions;
1. Yes, there is the change in schedule. Schedule has been changed according to her recovery and pain. Change in schedule may occur depending on athlete’s recovery and improvement. This is not unusual, and it may shorten or lengthen recovery time. Unfortunately, Jacquelyne’s recovery has delayed, and it is very frustrating for all of us.

2. Scheduling next doctor appointment is arranged in December 20, 2011 according to return to activity plan. As I mentioned above, Dr. Palmgren wants return to functional activity in 4-6 weeks after recent surgery. This plan is reasonable to me. I don’t think we can move next appoint up to November or early December because of this plan. We may push 1 week up which is week of December 12.

3. Here is a plan;
a. 1st week (11/06-11/12); Weight bearing with boot as tolerated
b. 2nd week (11/13-11/19); Weight bearing without boot as tolerated, Restore Full ROM, light weight bearing rehab, No impact activity
c. 3rd week (11/20-11/26); Progress weight bearing rehab, light impact rehab as tolerated
d. 4th week (11/27-12/03); Progress from light impact to moderate impact rehab, controlled slow speed and light impact functional activity as tolerated
e. 5-6th week 12/04-12/17); progress from controlled slow speed and light impact to moderated speed and impact functional activity

4. If there is no improvement and she cannot tolerate pain with functional activity (turning) or throwing, next option would be to proceed to the next surgery which is fusing lisfranc joint.

5. If she decides to have next surgery, the earliest she could throw is in 6 month, which is May if we could schedule surgery in December. The earliest we may be able to schedule surgery would be late December if Dr. Palmgren has open schedule. This means the earliest she may be able to throw is Late May, which most likely after Big 12 outdoor or very close.

6. Considering her recovery after first surgery, in my opinion, the possibility of her to return to throw would be more likely 9 – 12 month than 6 month. So the chances for her to compete in this season’s Big 12 are very low. But as I mentioned above, schedule may change, either shorter or longer, depending on her reaction of surgery and improvement.

7. My conclusion;

a. Conditions that she may throw this outdoor season
i. She improves and minimize pain with current rehab over next 4 months
ii. She has pain but can tolerate with functional activity, practice or throwing throughout this season

b. Conditions that She may not throw this outdoor season
i. She cannot tolerate pain with throwing
ii. She decides to have next surgery even scheduling surgery in December

c. If she chooses to have next surgery, return to throw will more likely 9-12 months.


I believe that I have done everything that possibly I could do for the best of Jacquelyne in terms of planning, scheduling with doctor, and rehab. Unfortunately, I have not seen good improvement in Jacquelyne’s foot. I am aware of this is very frustrating for Jacquelyne and you. I am also frustrated with her improvement, but I am also aware of that recovery from lisfranc injury is arduous and it sometime takes years. What we can do now is to be patient and do our best in any ways.

I had good conversation with Jacquelyne on Wednesday and I explained her everything I discussed on this email so we all should be on the same page.

I am sorry that it took a while to reply back your questions. I had discussed about your questions with Dr. Palmgren about future plan.
If you have any questions, please let me know.

Thank you,



Nobutaka "Nobu" Takashima

Assistant Athletic Trainer | Track and Field / Cross Country
K-State Athletics