A Lisfranc injury is a serious injury to the midfoot (the middle part of the foot), involving the bones or ligaments that support the arch. This type of injury can range from a mild sprain to complex fractures and dislocations. Lisfranc injuries are often missed at first but need careful attention because they can lead to long-term pain and problems if not treated properly. With early diagnosis and the right treatment, many people can recover good foot function and return to their usual activities.

A Lisfranc injury occurs when there is damage in the midfoot, where the long bones of the foot (metatarsals) meet the small bones that form the arch (cuneiforms and cuboid). This part of the midfoot, which is held together by strong ligaments, is called the Lisfranc joint complex, named after a French surgeon who first described injuries in this area. It is also known as the tarsometatarsal (TMT) joint complex.

The Lisfranc joint complex is held together by strong ligaments and forms the arch of the foot. When walking or running, the Lisfranc joint complex helps stiffen the arch and transfer push-off forces toward the toes. In a healthy foot, these structures stabilize the arch, providing the strength needed to push off the ground efficiently while walking and running. When these structures are injured, the midfoot can become unstable and weight can be unevenly distributed across the foot.

Lisfranc injuries can involve torn ligaments, broken bones, or both. The injury can be mild, affecting only one joint or ligament, or severe, involving several joints and multiple fractures. Even seemingly minor Lisfranc injuries can take months to heal. These injuries are uncommon, making up about 0.2% of all fractures, but they are often missed or mistaken for less serious problems. If not recognized and treated, Lisfranc injuries can lead to collapse of the foot’s arch, arthritis, and long-term disability.

Lisfranc injuries result from trauma to the midfoot, which can happen in a number of ways:

• Low-energy, indirect trauma: This cause of Lisfranc injuries is common in sports. It can occur when force is applied to a planted, downward-pointing foot. For example, if a foot is pointed downward and planted for push-off, a force—such as being stepped on—can cause the Lisfranc joint complex to twist or buckle, resulting in an injury. In sports that use a stirrup or foot strap, such as horseback riding or windsurfing, the front of the foot can get caught during a fall, and the midfoot can be forced to twist or buckle, causing a Lisfranc injury.
• High-energy, direct trauma: This type of trauma can occur in a number of ways, including motor vehicle collisions, falls from a height, and crush injuries. These often cause fractures, dislocated joints, and significant soft-tissue damage. Such injuries may accompany other foot or leg injuries and carry a higher risk of complications.

The main risk factors for a Lisfranc injury include certain activities, foot structure, and medical conditions. They may include:

• High-energy trauma (motor vehicle collision, fall from a height, crush injury)
• Sports that stress a downward-pointed foot with twisting (such as football, soccer, basketball, rugby)
• Sports and activities involving stirrups (equestrian, windsurfing)
• Athletes and people in high-performance athletic or physical training
• Certain midfoot shapes (for example, a shallow joint between midfoot bones or a relatively short second long bone of the foot)
• Having diabetes or neuropathy (nerve problems) can reduce foot sensation, making it easier to develop unnoticed injuries that may worsen over time

Symptoms of a Lisfranc injury usually involve pain, swelling, and difficulty using the foot. The severity of symptoms can range from mild to severe, depending on the extent of the injury. Symptoms may include:

• Midfoot pain and swelling
• Bruising on the top of the foot
• Bruising on the sole of the foot
• Pain that worsens with standing, walking, or pushing off
• Difficulty or inability to bear weight
• Tenderness when pressing on the midfoot
• Visible widening or flattening of the foot
• Numbness or altered sensation between the first and second toes in some subtle injuries
• Widening between the first and second toes (may happen with more severe injuries)
• Obvious deformity of the foot (in severe, high-energy injuries)

A Lisfranc injury is diagnosed through a combination of medical history, physical examination, and imaging tests.

The doctor may ask how the injury occurred, when symptoms began, and about any risk factors for a Lisfranc injury such as diabetes or nerve problems. During the physical exam, the doctor will look for swelling and tenderness over the midfoot, bruising on the sole of the foot, widening or flattening of the foot, and pain with gentle stress maneuvers of the midfoot. The doctor will also check blood flow and nerve function in the foot, because these can be affected if bones have shifted. If swelling and pain are severe, the doctor will evaluate the patient for acute compartment syndrome—a dangerous build-up of pressure in the foot that requires emergency surgery.

Imaging tests are used to confirm the diagnosis and determine the extent of the injury. These tests may include:

• X-rays: Show broken bones, joint alignment, and widening between the metatarsals. Standing X-rays in which the feet support body weight can reveal subtle widening or misalignment.
• Comparison X-rays: Images of both feet are often taken to use the uninjured foot as a guide for identifying bone alignment abnormalities in the injured foot.
• CT (computed tomography) scan: Provides detailed images of bone fractures and joint involvement, especially in complex or high-energy injuries.
• MRI (magnetic resonance imaging) scan: Shows ligament and soft-tissue injuries and can detect subtle injuries or those that involve only ligaments.
• Ultrasound: May help assess ligament injuries, but is less commonly used.

If initial X-rays are normal but symptoms and exam findings suggest a Lisfranc injury, advanced imaging (CT or MRI) is often needed. In some cases, stress tests or imaging under anesthesia may be used to uncover hidden instability.

Treatment for a Lisfranc injury depends on the severity and type of injury. The main goals are to restore stability to the midfoot, relieve pain, and prevent long-term complications. Treatments include both nonsurgical and surgical options:

• Protection and symptom control: Initial care often includes immobilization (for example, using a short-leg splint or boot), rest, ice, compression, elevation, and appropriate pain medication.
• Nonsurgical immobilization: For stable injuries in which bones have not shifted out of place, and for midfoot sprains without fractures, treatment typically involves keeping weight off the affected foot for approximately two months, with regular check-ups and X-rays to monitor healing. If symptoms and imaging improve, weight-bearing and rehabilitation begin gradually. If tenderness persists but imaging shows the bones are still in place, the immobilization period may be extended. For injuries involving ligament tears, the foot may need to be immobilized for several months.
• Open reduction and internal fixation (ORIF): This surgical procedure is used for injuries with unstable joints or bones that have shifted. The surgeon realigns the bones and restores normal position using plates and/or screws. In some cases, surgery happens in two steps. First, the surgeon uses pins or a small frame outside the foot to hold the bones together. Later, in a second surgery, the surgeon secures the bones permanently or, in some cases, fuses the joints.
• Fusion (arthrodesis): In some injuries that are either chronic or that involve joint destruction—both of which are high risk for post-traumatic arthritis—the surgeon may recommend joining certain midfoot joints, so they no longer move. These midfoot joints normally have very little motion, so fusion can relieve pain and restore function in the right candidates.
• Postoperative care and rehabilitation: After ORIF or fusion, non–weight-bearing in a cast or boot is typical for six to eight weeks. Once imaging scans show the injury is healing properly, gradual weight-bearing in a boot begins, followed by progression to supportive shoes. Physical therapy focuses on restoring motion, strength, balance, and walking mechanics. Arch supports or custom inserts are often used during recovery.

The choice between ORIF and fusion depends on the type of injury and patient needs. Both methods can lead to good outcomes if the bones are properly aligned.

Lisfranc injuries can lead to several complications, especially if not diagnosed or treated correctly. Complications may be acute (occurring shortly after the injury) or chronic (long-lasting). Potential complications include:

• Post-traumatic midfoot osteoarthritis: Wear-and-tear of damaged joints that leads to chronic pain and stiffness; common after severe injuries, even with proper treatment.
• Chronic midfoot pain and functional instability: Ongoing pain and a feeling that the foot is not stable during activities.
• Collapse or flattening of the arch (flatfoot): Instability in the midfoot can cause the arch to fall, leading to deformity and difficulty walking.
• Structural changes to the foot, such as visible sinking or sagging of the arch.
• Need for additional surgery: Some people later need hardware removal or midfoot fusion because of persistent pain or arthritis.
• Acute compartment syndrome: A dangerous pressure build-up in the foot after high-energy injuries; requires emergency surgery to relieve the pressure.
• Blood vessel or nerve injury: Can occur with severe dislocations or high-energy trauma.
• Wound complications, infection, and blood clots: More likely after high-energy trauma or in people with other medical conditions.
• Complications related to diabetes or nerve damage: People with reduced sensation in the foot have a higher risk of ulcers, infection, and a destructive joint condition called Charcot foot.

The outlook varies based on several factors, including whether the injury involves ligaments only or a fracture and/or dislocation, the severity of the injury, how quickly the injury is recognized, and how well the joints are realigned and stabilized. Many people recover good function and can return to daily activities, especially if the injury is recognized early and treated properly. Recovery can take several months, and some people may need up to a year to return to sports or high-impact activities.

Some people may have ongoing pain, stiffness, or difficulty with certain activities, even after successful treatment. The risk of developing arthritis or chronic problems is higher with severe injuries, delayed diagnosis, or poor alignment of the bones. Surgical techniques and rehabilitation have improved outcomes, but some patients may not regain their previous level of activity.

Overall, early diagnosis, proper treatment, and careful rehabilitation offer the best chance for a good recovery and return to normal life. Regular follow-up with the care team is important to monitor healing and address any problems that arise.

“What stands out about Yale Medicine’s approach to Lisfranc injuries is the combination of early, precise diagnosis, individualized surgical decision-making, and athlete-centered return-to-performance care—bridging academic rigor with real-world outcomes,” says Arianna Gianakos, DO, a Yale Medicine orthopaedic surgeon who specializes in sports-related injuries of the foot and ankle. “Yale emphasizes early recognition using advanced imaging, weight-bearing assessment, and clinical suspicion, preventing missed or delayed Lisfranc diagnoses. In addition, the team at Yale Medicine recognizes that this injury is not ‘one-size-fits-all’ and therefore provides tailored individual care.”