What is a Lisfranc injury?
A Lisfranc injury involves the Lisfranc joint complex — the point where the metatarsal bones (the long bones leading up to the toes) connect to the tarsal bones of the midfoot arch. The Lisfranc ligament is the key connective tissue band that holds this joint in alignment and gives the midfoot its stability. When that joint complex is damaged, the midfoot can lose its normal structure and strength.
Lisfranc injuries range from a mild sprain to a severe fracture-dislocation, and the severity varies widely from person to person. Because the injury is easy to mistake for a simple ankle or foot sprain, an accurate diagnosis by a foot and ankle specialist is essential to prevent long-term midfoot problems.
What are the symptoms of a Lisfranc injury?
The hallmark symptoms are swelling and pain across the midfoot, especially when bearing weight. Because the injury affects the structural core of the foot, symptoms often make walking or standing difficult. Common signs include:
- Swelling and pain on the top or arch of the midfoot
- Bruising or blistering on the top and bottom of the foot
- Pain that worsens with weight-bearing, running, or squatting
- Abnormal widening of the foot
- Inability to bear weight on the foot in more severe injuries
What causes a Lisfranc injury, and who is at risk?
Lisfranc injuries occur from either direct or indirect force to the midfoot. Direct trauma happens when a heavy object falls onto the foot or the foot is crushed, while indirect injuries typically result from a twisting force applied to a planted foot. These injuries are grouped into three categories:
- Sprains — stretching of the Lisfranc ligament that leaves the midfoot unstable
- Fractures — a break in one or more of the midfoot bones, either an avulsion or a break through the bone itself
- Dislocations — bones of the midfoot forced out of their normal position
People at higher risk include those involved in auto accidents, military personnel, runners, horseback riders, and contact-sport athletes. Everyday mishaps — such as missing a step on a staircase — can also cause this injury. Because Lisfranc injuries often accompany other trauma, they are frequently seen alongside toe and metatarsal fractures or fifth metatarsal fractures.
How do we diagnose a Lisfranc injury?
We diagnose a Lisfranc injury by combining a detailed history of how the injury occurred with a hands-on physical examination and imaging. X-rays are typically obtained first, often including weight-bearing views, since the joint can shift under load in ways that are not visible on a non-weight-bearing image. Advanced imaging such as a CT scan or MRI may be added to fully evaluate the ligaments and bones.
In some cases, your surgeon may perform an examination under anesthesia to stress-test the joint and assess fracture and ligament involvement more precisely. Because Lisfranc injuries are commonly mistaken for a simple ankle sprain, prompt evaluation by a foot and ankle specialist is important whenever midfoot pain follows a twisting injury or direct trauma.
How is a Lisfranc injury treated?
Treatment depends on the severity of the injury — whether it is a stable sprain or an unstable fracture-dislocation. Our physicians choose the least invasive approach that will restore stability and protect the joint for the long term.
Nonsurgical treatment
Stable, low-grade sprains without joint displacement can often be managed conservatively:
- Cast or boot immobilization with crutches to keep weight off the foot
- NSAIDs to reduce pain and inflammation
- Ice and elevation to control early swelling
- Physical therapy once the acute injury has settled, to restore strength and motion
Surgery
Certain types of Lisfranc injuries require surgery to restore alignment and stability, and some fracture-dislocations need urgent surgical intervention. The specific procedure depends on the pattern and severity of the injury, and may involve fixing the bones with screws or plates, or in some cases fusing part of the joint to provide lasting stability. Our surgeons will walk you through the recommended approach and what to expect at each stage.
What is recovery from a Lisfranc injury like?
Recovery timelines vary significantly based on whether the injury was treated nonsurgically or surgically and how severe the original damage was. Non-weight-bearing periods in a cast or boot are common early on, followed by a gradual, supervised return to weight-bearing and activity. Physical therapy plays an important role in regaining strength, balance, and normal walking mechanics.
Left untreated or undertreated, a Lisfranc injury can lead to lasting complications, including compartment syndrome (a dangerous buildup of pressure in the tissues that requires immediate surgery), midfoot arthritis that can develop months or years later, and permanent changes to foot alignment. That is why prompt, accurate diagnosis and a carefully followed treatment and recovery plan matter so much with this injury.
When should you see a podiatrist for a Lisfranc injury?
See a foot and ankle specialist right away if you have midfoot swelling, bruising, or pain after a twisting injury, a fall, or a heavy object striking your foot — especially if you cannot bear weight comfortably. Because Lisfranc injuries are often mistaken for a routine sprain, any midfoot pain that does not improve quickly with rest deserves a professional evaluation.
Seek urgent care if you notice severe swelling, numbness, color changes in the toes, or an inability to move the foot, as these can signal a more serious injury or complication. You can request an appointment at either of our Northern Utah offices.
Why choose Wasatch Foot & Ankle Institute?
Wasatch Foot & Ankle Institute is a locally rooted podiatry practice serving Farmington, South Ogden, and the surrounding Davis and Weber County communities. Our board-certified, fellowship-trained physicians focus exclusively on the foot and ankle, including complex midfoot trauma like Lisfranc injuries that require careful diagnosis and, at times, surgical correction.
That focus lets us manage your care from initial evaluation and imaging through nonsurgical treatment, surgery when needed, and a full recovery and rehabilitation plan — all under one roof. Learn more about our Farmington and South Ogden locations or call the office nearest you.
Medically reviewed by the physicians at Wasatch Foot & Ankle Institute. Our board-certified, fellowship-trained podiatrists provide foot and ankle care in Farmington and South Ogden, Utah. This page is for general education and is not a substitute for an in-person evaluation.