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Lisfranc Fracture

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A Lisfranc injury affects the midfoot — specifically the joints where the long metatarsal bones meet the small tarsal bones. These joints form the arch of the foot and are vital for weight-bearing and stability. Injuries can involve fractures, ligament tears, or both. Prompt diagnosis is essential to avoid long-term joint collapse or arthritis.

Symptoms

• Pain and swelling in the midfoot, especially after injury or twisting
• Inability to bear weight
• Bruising on the sole of the foot — a key diagnostic sign
• Pain that worsens with walking or standing
• Visible foot deformity in severe cases

Diagnosis

Confirmed by weight-bearing X-rays. CT scan or MRI may be used to assess subtle joint damage or ligament injury.

Causes

• High-energy trauma such as a car accident or fall from height
• Twisting injuries (e.g. stepping into a hole with the foot flexed)
• Sports injuries — particularly contact sports or equestrian activities

Non-Surgical Treatment

Only appropriate for stable, non-displaced injuries: non-weight-bearing in a cast for six weeks, then transition to a walking boot with gradual return to activity, plus arch support or orthotics.

Surgical Treatment

Most Lisfranc injuries require surgery due to displacement or instability. Options include:

• Open reduction and internal fixation (ORIF) using screws and/or plates
• Fusion surgery where joints are severely damaged

Screws may be left in place or removed at a later stage depending on the case. A lifelong medial arch support is often required to protect the midfoot long-term.

Recovery

Timeframe	What to Expect
0–6 weeks	Non-weight-bearing in cast. Foot elevated.
6–8 weeks	Cast removed. Transition to boot. Begin weight-bearing.
8–12 weeks	Gradual return to walking. Physiotherapy begins.
3–6 months	Improved mobility. Orthotics usually required long-term.
6–18 months	Return to sport if healing is complete and pain manageable.