Lisfranc Injury

What is a Lisfranc Injury?

A Lisfranc injury is a type of midfoot injury that involves the tarsometatarsal (TMT) joints, which connect the long bones of the forefoot (metatarsals) to the bones of the midfoot. These injuries can range from simple ligament strains to complex fracture-dislocations. Although rare, they are serious and often require surgical treatment.

The Lisfranc joint complex plays a critical role in stabilising the arch of the foot. Damage to this area, whether from trauma, a twist, or heavy impact, can disrupt normal foot mechanics, leading to long-term pain or disability if not correctly diagnosed and treated.

What are the Types of Lisfranc Injuries?

Lisfranc injuries can be broadly classified into the following types:

• Ligamentous Lisfranc Injuries involve tears or ruptures of the Lisfranc ligament without any associated bone fracture. They are easily missed on initial assessment and may only be detected through stress tests or advanced imaging.
• Fracture–Dislocation Lisfranc Injuries: These involve both ligament damage and fractures of the surrounding bones. They are more obvious on X-rays and often present with swelling, bruising, and difficulty weight-bearing.
• Subacute or Chronic Lisfranc Injuries occur when an acute injury is missed or not properly treated. Over time, the instability can lead to midfoot arthritis and deformity. Chronic injuries may require joint fusion (arthrodesis) to restore foot function.

Early diagnosis and rapid commencement of treatment are critical to avoid long-term complications from Lisfranc injuries. The Access Ortho Fracture clinics in Brisbane, Indooroopilly, and Ipswich treat Lisfranc injuries. 

How Common Are Lisfranc Injuries?

Lisfranc injuries are relatively uncommon, accounting for less than 1% of all fractures. Despite their rarity, they are often underdiagnosed, especially when the injury is purely ligamentous and no bones are visibly broken on initial X-rays.

These injuries can occur in anyone, but are more frequently seen in:

• Athletes involved in high-impact sports, for example, football, rugby, or gymnastics
• Individuals involved in motor vehicle or crush injuries
• People who twist their foot unexpectedly during a fall or misstep

Because Lisfranc injuries can be easily mistaken for a simple sprain, it’s important to seek expert assessment if midfoot pain persists or there is bruising on the sole of the foot—a key sign of this injury.The orthopaedic team at Access Ortho are skilled in diagnosing and caring for Lisfranc injuries.

Symptoms and Causes

What are the Symptoms of Lisfranc Injuries?

The symptoms of a Lisfranc injury can vary depending on the severity. Common symptoms include:

• Pain in the midfoot, especially when standing or walking
• Swelling on the top of the foot
• Bruising under the foot (plantar ecchymosis), which is a key indicator of midfoot ligament injury
• Inability to bear weight or limping
• Tenderness over the top of the midfoot
• Widening or instability of the forefoot

These symptoms may initially appear mild, which is why some Lisfranc injuries are mistaken for simple sprains.

What Causes Lisfranc Injuries?

Lisfranc injuries can occur through both direct and indirect trauma. Common causes include:

• High-energy trauma: Motor vehicle accidents, falls from a height, or crush injuries can cause fractures and dislocations in the midfoot.
• Low-energy mechanisms: Twisting the foot during a fall, stumbling while the foot is planted, or missing a step can lead to ligament tears or subtle fractures.
• Sports injuries: Sudden directional changes or impact during sports like football, soccer, and rugby frequently cause Lisfranc injuries.

What are Lisfranc Injury Risk Factors?

There are a variety of factors that can increase the likelihood of sustaining a Lisfranc injury:

• Participation in high-impact or contact sports
• Activities that involve twisting or pivoting motions
• Previous foot injuries or instability
• Wearing inappropriate or unsupportive footwear during physical activity
• Bone or ligament weakness (e.g. due to osteoporosis or connective tissue disorders)

What are the Complications of Untreated Lisfranc Injuries?

If not diagnosed and managed appropriately, Lisfranc injuries can lead to significant long-term issues, including:

• Chronic foot pain
• Midfoot arthritis due to joint damage and instability
• Flattening of the foot arch, leading to altered gait and discomfort
• Persistent swelling or stiffness in the midfoot
• Loss of mobility and difficulty with high-impact activities

Timely diagnosis and correct treatment are essential to avoid these complications and ensure a full recovery. Access Ortho Fracture clinics offer rapid care for foot injuries, including Lisfranc injuries, in their Brisbane (Indooroopilly) and Ipswich clinics. 

Diagnosis and Tests

How are Lisfranc Injuries Diagnosed?

Diagnosing a Lisfranc injury begins with a careful clinical assessment. Your medical provider will ask about how the injury occurred and examine your foot for signs such as tenderness over the midfoot, swelling, bruising (especially on the sole), and pain when bearing weight.

Because symptoms can be subtle, especially in purely ligamentous injuries, Lisfranc injuries are sometimes missed on initial assessment. If there is any suspicion, further imaging should be requested to confirm the diagnosis and guide treatment.

At Access Ortho, your appointments are with medical providers skilled in caring for orthopaedic injuries. 

Which Tests do Providers Use to Diagnose Lisfranc Injuries?

Several tests and imaging tools are used to accurately diagnose Lisfranc injuries:

• X-rays: The first step usually includes standard foot X-rays: anteroposterior (AP), oblique, and lateral views. Weight-bearing X-rays (done after initial swelling subsides) can help detect joint instability.
• Stress tests: Your clinician may perform specific clinical tests, such as the TMT squeeze test or the abduction-pronation manoeuvre, to detect midfoot instability.
• CT (Computed Tomography): A CT scan provides detailed images of bone alignment and can detect small fractures or subtle displacement. It’s especially useful for surgical planning.
• MRI (Magnetic Resonance Imaging):  When X-rays and CT scans are inconclusive, MRI is used to assess ligament damage. It’s particularly helpful for detecting purely ligamentous injuries.
• Ultrasound (less commonly): May assist in some soft tissue evaluations, but is not a primary tool for Lisfranc injuries.

Diagnosis requires a combination of tests and specialist input, especially when surgical intervention is being considered.

Specific Considerations for Lisfranc Injuries

Lisfranc injuries are complex and often require a nuanced approach to diagnosis and treatment. Key considerations include:

• High rate of missed diagnosis: Ligamentous injuries without fractures may not show up clearly on initial X-rays, making clinical suspicion essential.
• Importance of early specialist involvement: These injuries often require surgical management, so early review by an orthopaedic surgeon is crucial.
• Weight-bearing status: Patients are usually placed in a moon boot or cast and kept non-weight bearing until further imaging confirms stability.
• Surgical decision-making: Depending on the injury pattern, patients may require internal fixation or even joint fusion (arthrodesis), particularly in high-grade ligamentous injuries or chronic cases.

Sports-Related Lisfranc Injuries

Athletes are particularly at risk of Lisfranc injuries, especially those in contact or pivoting sports like football, rugby, soccer, and gymnastics. In sports settings:

• Injuries may occur through twisting or impact while the foot is planted.
• Athletes may initially continue playing, mistaking the injury for a sprain.
• Subtle ligamentous injuries are common and can delay diagnosis.
• Return-to-sport requires full rehabilitation and confirmation of joint stability, often taking 3–4 months or more.

Prompt diagnosis and sport-specific rehabilitation are essential to minimise long-term complications and enable a safe return to activity.

Subtle vs. Obvious Lisfranc Injuries

Lisfranc injuries can range from subtle ligament tears to obvious fracture-dislocations. Understanding this spectrum is vital for correct diagnosis:

• Subtle injuries: Often purely ligamentous. May present with minimal swelling and normal-looking X-rays. Require high clinical suspicion, stress tests, and advanced imaging (MRI or weight-bearing X-rays).
• Obvious injuries: Fracture-dislocations or displaced injuries are usually visible on plain X-rays and present with significant swelling, pain, and bruising. These often need urgent orthopaedic referral and surgical treatment.

Because subtle injuries can cause just as much long-term damage if missed, clinicians must treat midfoot pain seriously, even in the absence of clear radiographic findings. Access Ortho offers rapid appointments for patients with acute musculoskeletal injuries. 

Management and Treatment

How are Lisfranc Injuries Treated?

Treatment for Lisfranc injuries will vary depending on the severity and stability of the injury. While some stable injuries may heal with rest and immobilisation, many cases, especially those involving joint instability or fractures, require surgical intervention to restore foot alignment and function.

Non-Surgical Treatment for Lisfranc Injuries

Non-operative treatment may be appropriate in the following situations:

• Mild injuries with no displacement
• Stable ligamentous injuries confirmed on weight-bearing imaging
• Minimal or no involvement of joint surfaces

Treatment typically includes:

• Moon boot or cast: Immobilisation for 6–8 weeks to protect the midfoot and allow healing
• Non-weight bearing: Patients may need crutches or a scooter to help avoid putting weight on the foot initially
• Elevation and pain management: Especially important during the acute phase to reduce swelling

Patients are reviewed regularly with imaging (including weight-bearing X-rays) to ensure no delayed displacement has occurred.

Surgical Treatment Options for Lisfranc Injuries

Surgery is often required when:

• There is displacement of bones at the Lisfranc joint
• The Lisfranc ligament is ruptured and the joint is unstable
• There is significant cartilage or joint surface damage
• The injury is chronic or was missed initially

Surgical options include:

• Open Reduction and Internal Fixation (known as ORIF): This technique involves realigning the bones and stabilising them with plates and screws.
• Primary Arthrodesis (Fusion): Fusing the affected joints, which may provide better long-term outcomes for high-grade ligamentous injuries or chronic cases.

Early review by an orthopaedic surgeon is essential to determine the most appropriate surgical approach.

Access Ortho offers rapid access to Orthopaedic Surgeons. 

Rehabilitation After Lisfranc Injury Treatment

Recovery from a Lisfranc injury, whether treated surgically or non-surgically, requires a carefully guided rehabilitation process:

1. Immobilisation phase (typically 6–8 weeks): Usually non-weight bearing in a moon boot or cast
2. Gradual return to weight-bearing: Under medical supervision, weight-bearing is reintroduced once healing is confirmed
3. Physiotherapy: Focuses on restoring foot strength, range of motion, and balance
4. Return to activity: High-impact activities and sports are gradually reintroduced, typically around 3–4 months post-injury, depending on healing and stability
5. Follow-up imaging: May be required at 6 weeks or later to confirm fracture union, particularly if surgical treatment was performed

Full recovery can take several months, and some patients may experience ongoing stiffness or discomfort, particularly after more complex injuries.

Prevention

How Can I Prevent Lisfranc Injuries?

While not all Lisfranc injuries can be prevented, certain strategies can reduce your risk, particularly if you’re active or returning to sport:

• Strengthen the foot and ankle muscles: Exercises that improve stability and control may help protect the midfoot during sudden movements or uneven landings.
• Avoid overtraining: Gradually increase the intensity and length of activity to prevent fatigue-related injuries.
• Be cautious during high-risk activities: Sports involving twisting, pivoting, or contact carry a higher risk. Always warm up properly and use good technique.
• Pay attention to midfoot pain: Don’t ignore bruising, swelling, or pain in the arch or top of your foot, especially after a fall or misstep. Early evaluation is key to avoiding complications.

Footwear Considerations for Lisfranc Injury Prevention

Wearing appropriate footwear is essential in reducing your risk of Lisfranc and other midfoot injuries:

• Choose supportive shoes: Look for footwear that offers strong arch support and a stable midsole, especially for sports or long hours on your feet.
• Replace worn-out shoes: Shoes lose support over time. It is important to look for signs of wear, especially in the sole and arch areas.
• Use sport-specific shoes: Different activities require different levels of stability, grip, and cushioning. Use the right shoes for running, field sports, or court sports.
• Avoid unsupportive footwear: High heels, soft-soled shoes, or flat thongs offer little midfoot protection and increase the risk of injury during sudden movements.

Orthotics or custom insoles may also be recommended for people with flat feet, high arches, or a history of foot injuries.

Outlook / Prognosis

What Can I Expect if I Have a Lisfranc Injury?

If you’ve been diagnosed with a Lisfranc injury, it’s important to know that while these injuries can be serious, good outcomes are possible with early diagnosis, appropriate treatment, and guided rehabilitation. You can expect:

• A period of rest and immobilisation (in a moon boot or cast)
• Further imaging to guide treatment decisions
• Regular reviews to monitor healing
• Possible surgical intervention depending on the severity
• A gradual return to weight-bearing and activity under medical supervision

Recovery takes time, and it’s normal to experience swelling, stiffness, or sensitivity in the foot during healing. With the right care, most patients make a strong recovery.

What is the Recovery Time from a Lisfranc Injury?

Recovery time will differ depending on the severity of the injury and whether surgery is needed:

• Non-surgical recovery: Typically 8–12 weeks in a boot or cast, with full return to activity over 3–4 months
• Surgical recovery: Can take longer—generally 3–6 months for healing, with some patients requiring up to a year for full return to high-impact activities

Rehabilitation is a gradual process and may involve physiotherapy to regain strength, flexibility, and balance. Your orthopaedic team should guide you on your expected recovery time. 

Will I Need Surgery for My Lisfranc Injury?

Surgery is required for many Lisfranc injuries, particularly if there is:

• A fracture or joint displacement
• Ligament rupture causing instability
• Chronic injury that didn’t heal properly

Your treatment team will use imaging (X-rays, CT, and sometimes MRI) to determine whether the joint is stable enough to heal on its own or if surgical fixation or fusion is needed. Early specialist input is critical to making the right treatment decision. Access Ortho offers rapid access to Orthopaedic Specialists. 

Can I Play Sports After a Lisfranc Injury?

Most people can return to sports after a Lisfranc injury, though the timeline depends on the injury and the demands of your sport.

• Non-contact and low-impact sports may be resumed earlier (around 3–4 months)
• High-impact or contact sports may require a longer rehabilitation period (up to 6–12 months)
• A structured return-to-sport program guided by your healthcare provider or physiotherapist ensures a safe and confident return to play

Some athletes may notice subtle changes in performance or midfoot stiffness, but with proper care and conditioning, full participation is achievable.

When Should I Go to a Fracture Clinic for Midfoot Pain?

If you’re experiencing persistent pain, bruising, or swelling in the middle of your foot, especially after a twist, fall, or sports injury, it’s important not to dismiss it as a simple sprain. Midfoot injuries like Lisfranc injuries can be easily missed but may have long-term consequences if left untreated.

You should visit a fracture clinic like Access Ortho if you have:

• Midfoot pain that worsens with standing or walking
• Bruising on the bottom of your foot
• Swelling or tenderness over the arch
• Difficulty bearing weight
• A recent foot injury with ongoing symptoms

Access Ortho offers rapid assessment, referral for and review of imaging, and access to orthopaedic-trained clinicians who can diagnose and manage foot and ankle injuries without the long waits of the emergency department. Early and accurate care makes a big difference in recovery—don’t delay if you’re unsure.

What is a Foot and Ankle Fracture Clinic?

A Foot and Ankle Fracture Clinic is a specialised service designed to diagnose and manage foot and ankle injuries, including fractures, ligament injuries, and joint instability. These clinics provide targeted care, often with faster access to appropriate imaging and orthopaedic input than general medical services.

At Access Ortho, we offer:

• Expert evaluation by clinicians experienced in foot and ankle injuries
• Referrals for X-Rays and advanced imaging, such as CT or MRI, when needed
• Moon boot fitting, crutches, and recovery plans tailored to your injury
• Reviews with orthopaedic surgeons 
• Streamlined specialist follow-up to ensure optimal recovery

Whether it’s a suspected Lisfranc injury or a general midfoot concern, Access Ortho’s fracture clinics in Brisbane and Ipswich provide fast, focused, and friendly care, helping you get back on your feet sooner.

Commonly Asked Questions About Lisfranc Injuries

How do I know if my foot pain is a Lisfranc injury or just a sprain?

Lisfranc injuries often mimic sprains but usually cause more midfoot pain, especially when standing or walking. Bruising under the arch (plantar bruising) is a key sign of a Lisfranc injury. If pain persists, imaging is essential; X-rays, CT, or MRI may be needed to confirm the diagnosis.

Can you walk with a Lisfranc injury?

Some patients can walk with a mild or subtle Lisfranc injury, which is why it’s often misdiagnosed. However, walking on an unstable injury can worsen damage. If walking is painful or you have swelling or bruising in the midfoot, seek medical review promptly.

How long will I need to wear a boot for a Lisfranc injury?

Most patients wear a moon boot or cast for 6–8 weeks. This may be longer after surgery or if healing is slow. At follow-up, your doctor will guide your weight-bearing status based on X-rays or other scans.

Will I need crutches after Lisfranc injury surgery?

Yes. You’ll typically be non-weight bearing for at least 4–6 weeks after surgery. Crutches, a scooter, or a walker will help keep weight off the injured foot during healing.

What type of shoes should I wear after recovering from a Lisfranc injury?

Supportive, cushioned footwear with a firm sole and good arch support is recommended. Avoid flexible-soled shoes or high heels early on. Your provider may recommend custom orthotics if there’s arch pain or altered foot mechanics.

How successful is surgery for Lisfranc injuries?

Surgery has high success rates when performed early and appropriately. Most patients regain good function, although some experience mild stiffness or activity limitations. Outcomes are better when the injury is stabilised before walking resumes.

Will I develop arthritis after a Lisfranc injury?

There is a risk of post-traumatic arthritis, especially if the joint surfaces are damaged or if the injury is missed. Surgical fusion (arthrodesis) may be recommended to prevent or manage arthritis in more severe cases.

When can I drive after Lisfranc injury surgery?

You can usually drive once you’re fully weight-bearing, can safely control the pedals, and are no longer using a boot or crutches—generally around 6–8 weeks after surgery. Always check with your doctor and insurer before resuming driving.

How long will I be off work with a Lisfranc injury?

Time off work depends on your job. Desk-based workers may return rapidly if non-weight bearing is manageable. Jobs that require standing, walking, or manual labour may require 2–3 months or more off work, particularly after surgery.

Can I run again after a Lisfranc injury?

Many people return to running after a Lisfranc injury, especially with early diagnosis and proper rehab. Return to impact sports usually takes 4–6 months or longer, depending on healing, strength, and joint stability.

What happens if a Lisfranc injury is missed or left untreated?

Untreated Lisfranc injuries can lead to long-term problems such as chronic pain, foot deformity, arthritis, and loss of foot function. Early diagnosis and correct treatment are critical for preventing these outcomes.

Will I need hardware removal after Lisfranc surgery?

Some patients require removal of plates or screws once healing is complete, especially if the hardware causes discomfort. Others may retain the hardware long-term without issues. Your surgeon will monitor and advise based on follow-up imaging and symptoms.

How painful is recovery from Lisfranc surgery?

Pain is common in the early post-op period but can be controlled with medication, rest, and elevation. Discomfort generally improves over weeks. Swelling and stiffness can persist for months, particularly with weight-bearing.

Can I avoid surgery for my Lisfranc injury?

If the injury is stable with no displacement or joint instability, it may be managed without surgery. However, most moderate to severe Lisfranc injuries do require surgical fixation or fusion for the best outcomes.

Why is my foot still swelling months after a Lisfranc injury?

Prolonged swelling is common, especially after surgery or more complex injuries. It may persist for several months as the body continues healing. Elevation, compression, and guided rehab can help manage this.

What is the difference between a Lisfranc fracture and a Lisfranc sprain?

A Lisfranc fracture involves broken bones in the midfoot. A Lisfranc sprain refers to tearing or stretching of the Lisfranc ligament without any bone break. Both can be serious and require specialist care to ensure the joint remains stable. They can also occur in combination. 

Do I need custom orthotics after a Lisfranc injury?

Custom orthotics may be helpful if you have ongoing arch pain, altered foot posture, or difficulty returning to normal footwear. They support the midfoot and help prevent reinjury during daily activities or sports.

Can I still play sports professionally after a Lisfranc injury?

Many athletes return to competitive sports after a Lisfranc injury, particularly with early treatment, surgery if needed, and a well-structured rehab plan. Recovery time varies, but full return to play is achievable for most.

How do surgeons fix a Lisfranc injury?

Surgical options include:

• Open Reduction and Internal Fixation (ORIF) – The injured bones are aligned and secured with screws or plates
• Arthrodesis (fusion) – Fusing the injured joints in severe or chronic cases to eliminate pain and instability

The chosen method depends on the type of injury and the stability of the joint.