Understanding Lisfranc Injuries: Causes, Symptoms, and Treatment

The midfoot plays an essential role in supporting body weight, maintaining balance, and enabling smooth movement while walking or running. A Lisfranc injury—named after a French surgeon who first identified the condition—involves damage to the bones or ligaments in this crucial part of the foot. Although relatively uncommon, these injuries can be serious and often require prompt orthopedic evaluation.

What Is a Lisfranc Injury?

The Lisfranc joint complex includes the bones and ligaments that connect the midfoot to the forefoot. These structures help stabilize the arch and transfer force with each step. Injury occurs when these ligaments are torn or when the bones in this area are fractured or displaced.

Common Causes

Lisfranc injuries can result from:
High-energy trauma: Car accidents or falls from height.
Sports injuries: Twisting the foot, especially when the toes are planted and the heel abruptly pivots.
Low-energy accidents: Missing a step, stumbling, or twisting the foot during everyday activities.
Although athletes are at increased risk, anyone can sustain this type of injury.

Symptoms to Watch For

Patients often report:

Pain on the top of the foot, especially when bearing weight
Swelling and bruising
Tenderness in the midfoot region
Difficulty walking or standing on the affected side
Pain when pushing off the foot or trying to rise onto the toes
Bruising on the bottom (plantar surface) of the foot can be a red flag for ligament injury.

Diagnosis

An orthopedic specialist will evaluate the injury through:

Physical examination
X-rays, sometimes taken while standing to assess alignment
CT or MRI scans if more detailed imaging is needed
Early and accurate diagnosis is important to prevent long-term complications.

Treatment Options

Treatment depends on the severity of the injury:
Nonsurgical Treatment
Mild sprains without bone displacement may be treated with:
Immobilization in a cast or boot
Strict non-weight-bearing for several weeks
Physical therapy once healing begins

Surgical Treatment

Moderate to severe injuries, especially those involving bone displacement or ligament rupture, typically require surgery. Procedures may include:
Internal fixation: Realigning and securing bones with screws or plates
Fusion: Joining certain bones permanently to improve stability in chronic or severe cases
Surgery is often recommended to restore proper foot alignment and protect the long-term function of the arch.

Recovery and Rehabilitation

Healing from a Lisfranc injury takes time. Patients can expect:

A period of immobilization and non-weight-bearing
Gradual return to walking with guided physical therapy
Progressive strengthening, stretching, and balance exercises
Complete recovery may take several months, depending on injury severity and treatment type.

When to Seek Medical Attention

Anyone experiencing persistent midfoot pain, swelling, bruising, or difficulty bearing weight after an injury should see an orthopedic specialist promptly. Early evaluation reduces the risk of chronic instability and arthritis.

The Bottom Line

Lisfranc injuries affect a vital part of the foot and can significantly impact mobility if not treated appropriately. With timely diagnosis and the right treatment plan—whether conservative care or surgical repair—most patients recover stability and function and return to their everyday activities.