Lisfranc Injury
A Lisfranc injury is damage to the bones or ligaments at the Lisfranc joint complex — where the metatarsal bones of the forefoot meet the tarsal bones of the midfoot. These injuries range from mild ligament sprains to severe fracture-dislocations and are frequently misdiagnosed as simple foot sprains. Lisfranc injuries occur in athletes from low-energy twisting mechanisms and in non-athletes from falls or direct trauma such as a heavy object dropping on the foot.
Find a SpecialistWhat is Lisfranc Injury?
A Lisfranc injury is damage to the bones or ligaments at the Lisfranc joint complex — where the metatarsal bones of the forefoot meet the tarsal bones of the midfoot. These injuries range from mild ligament sprains to severe fracture-dislocations and are frequently misdiagnosed as simple foot sprains. Lisfranc injuries occur in athletes from low-energy twisting mechanisms and in non-athletes from falls or direct trauma such as a heavy object dropping on the foot.
Last reviewed May 8, 2026 by AdvOrtho Editorial Team
Informational, not medical advice
Symptoms
- Pain and swelling across the top of the midfoot
- Bruising on the bottom (sole) of the foot — a hallmark sign of Lisfranc injury
- Inability or significant difficulty bearing weight on the foot
- Visible widening or deformity of the foot in displaced injuries
- Point tenderness over the midfoot joints when pressed
- Pain that worsens with rotation or twisting of the forefoot
When to See a Doctor
Seek evaluation promptly if you cannot bear weight after a midfoot injury or notice bruising on the bottom of your foot. Lisfranc injuries are frequently missed initially — weight-bearing X-rays and sometimes a CT scan are necessary for accurate diagnosis. Early treatment prevents long-term deformity and arthritis.
Treatment Options
Non-weight bearing in a cast or boot
For purely ligamentous injuries without displacement on weight-bearing X-rays, 6-8 weeks of strict non-weight bearing with close imaging follow-up. Any displacement on weight-bearing views requires surgery.
Open reduction and internal fixation (ORIF)
Surgery to realign and stabilize displaced fractures or ligamentous dislocations using screws or plates. Hardware screws through ligamentous joints are often removed at 3-4 months to restore some motion. Recommended for most displaced Lisfranc injuries.
Primary arthrodesis (fusion)
Fusion of the involved Lisfranc joints is increasingly preferred for purely ligamentous Lisfranc injuries, with studies showing better long-term functional outcomes than temporary screw fixation. Mobility loss is modest as these joints normally have limited motion.
Recovery Timeline
Non-surgical treatment: non-weight bearing for 6-8 weeks, then progressive loading over 3-4 months, with return to sport at 4-6 months. Surgical treatment: non-weight bearing for 6-8 weeks, gradual weight bearing from weeks 8-12, return to sport at 4-6 months for most patients, with some athletes requiring 9-12 months.
Frequently Asked Questions
How is a Lisfranc injury different from a foot sprain?
Lisfranc injuries involve the midfoot joints — far deeper and more structurally important than a typical ankle sprain. The hallmark signs are bruising on the bottom of the foot and inability to bear weight, neither of which is typical of a simple sprain. Misdiagnosing a Lisfranc injury as a sprain and allowing early weight-bearing can cause permanent deformity and post-traumatic arthritis.
Do I need surgery for a Lisfranc injury?
Most Lisfranc injuries with any measurable displacement on weight-bearing X-rays require surgery. Purely stable ligamentous injuries without displacement can be treated non-surgically with a period of strict non-weight bearing, but these cases require close monitoring because displacement can develop. A foot and ankle specialist should make this determination with weight-bearing imaging.
What type of doctor treats Lisfranc injuries?
Foot and ankle orthopedic surgeons are the primary specialists for Lisfranc injuries. Because these injuries are frequently misdiagnosed in emergency settings, seeing a foot and ankle specialist is strongly recommended when a Lisfranc injury is suspected, even if initial imaging appears normal.
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This information is for educational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.