A Lisfranc injury damages the joints of the midfoot — the complex of bones and ligaments that connect your metatarsals (the long bones leading to your toes) to the rest of your foot. Because this joint complex bears weight with every step, a Lisfranc injury can make standing or walking painful, or even impossible, until it's properly diagnosed and treated.
The foot is one of the most structurally complex parts of the body, with dozens of bones, joints, and ligaments working together to absorb impact and support your weight. The Lisfranc joint sits at the center of that structure, just ahead of the ankle, which is why an injury there can be easy to underestimate — and why getting an accurate diagnosis matters.
What is a Lisfranc injury?
The Lisfranc joint complex connects the metatarsal bones to the midfoot, and it plays a key role in transferring load through the foot as you walk or run. A Lisfranc injury involves damage to the bones, the ligaments, or both, and it can also affect the surrounding cartilage. Injuries range from a partial ligament sprain to a full dislocation, so severity — and treatment — varies widely from case to case.
What causes a Lisfranc injury?
Lisfranc injuries most often occur when something heavy is dropped directly onto the foot, or when the foot is forcefully twisted while flexed downward — for example, a fall where the foot is planted and the body rotates. Because of this mechanism, Lisfranc injuries are seen frequently among:
- Contact sport athletes (football, soccer, rugby)
- Runners
- Military personnel
- Horseback riders
That said, a Lisfranc injury can also result from a simple misstep, an awkward landing, or a car accident — you don't have to be an athlete to sustain one.
What are the symptoms of a Lisfranc injury?
Because the midfoot is easy to overlook compared to more commonly injured areas like the ankle, Lisfranc injuries are sometimes missed on initial evaluation. Watch for:
- Swelling and pain across the midfoot, especially with pressure
- Bruising on the top of the foot or the arch — bruising on the arch in particular is a red flag
- Abnormal widening or flattening of the foot's arch
- Pain that makes it difficult or impossible to bear weight
If you have midfoot pain and swelling after an injury — especially with bruising on the sole of your foot — it's worth having it evaluated promptly rather than waiting to see if it improves on its own.
What are the types of Lisfranc injuries?
Lisfranc injuries generally fall into three categories:
- Sprains — the ligaments connecting the midfoot bones are stretched, causing instability without a break
- Fractures — one or more bones break, commonly as a small avulsion fracture where a ligament pulls a fragment of bone away
- Dislocations — the bones are forced out of their normal alignment
Many Lisfranc injuries involve a combination of these — for example, a fracture alongside ligament damage — which is why imaging is essential for an accurate diagnosis.
How is a Lisfranc injury diagnosed and treated?
Diagnosis starts with a physical examination and X-rays to assess the alignment of the midfoot bones; your podiatrist may also order weight-bearing X-rays or advanced imaging like a CT scan if a subtle injury is suspected.
Treatment depends on the severity of the injury. Stable sprains without a fracture or misalignment are often treated non-surgically with immobilization in a cast or boot, anti-inflammatory medication, ice, and elevation for roughly six to eight weeks, followed by a gradual return to weight-bearing and physical therapy. Injuries involving a fracture, joint instability, or dislocation typically require surgery to restore normal alignment and allow the joint to heal properly — leaving a Lisfranc injury untreated or improperly aligned can lead to chronic pain and early arthritis in the midfoot.
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 article is for general education and is not a substitute for an in-person evaluation.