Lisfranc Injury

What is it?

A Lisfranc injury involves the joints and/or the ligaments of the middle of the foot.  The injury can result from a major accident or a simple slip and fall.  Sometimes this injury can be mistaken for a “sprain” and not obtaining treatment can sometimes lead to more significant problems.  The degree of injury can range from mild to severe.

Symptoms and Clinical Presentation

Common symptoms of a Lisfranc injury are swelling and pain on the top of the foot.  Bruising is common, and bruising on the bottom of the foot is a clue this injury has occurred.  The appearance of the foot may range from grossly distorted in severe injuries to a normal appearance and normal ability to put weight on the foot with only pain in subtle injuries.

Cause (including risk factors) 

These injuries may be low-energy and result from a slip and fall.  This frequently occurs during athletic injuries but can also occur from a misstep or even missing a stair and stumbling over the top of the foot.  High-energy injuries occur from direct trauma such as a car accident or fall from a height.​ 

Anatomy 

The midfoot area is comprised of the joints and ligaments in the middle of the foot.  The bones in this area are held together by a specialized ligamentous and bony complex in which the bones key together like puzzle pieces to maintain the arch of the foot.  When the ligaments and/or bones in this area are injured, they may shift out of place disrupting their normal relationship. 

Diagnosis

The diagnosis of a Lisfranc injury is made from your symptoms, performing an exam, reviewing xrays, and sometimes additional tests.  Your doctor will examine the middle part of your foot to identify the location(s) of pain and perform specialized tests to check the stability of this area.  X-rays may demonstrate broken and or shifted bones in the middle of the foot.  Sometimes X-rays wihile atanding or with pressure applied in order to identify shifting of bones in the foot.  MRI may be helpful to see if the ligaments in the foot are damaged.  CT scan can help determine the extent of the bone injury and is useful when planning surgery. 

Treatment Options 

If the ligaments and the bones in the middle of the foot are not injured severely, and bones are not shifted out of their normal positions, non-surgical treatment can be successful with casting and staying of the foot.  This is generally needed for 6 weeks. Your doctor will follow-up regularly with x-rays to assure the bones maintain their good position during the recovery.  If the bones or ligaments are injured causing them to shift out of their normal positions, surgery is likely necessary to restore the anatomy  Often these plates and screws are removed later once the bones and ligaments have healed. 

Recovery 

The expected recovery depends on the initial severity of the injury.  For most cases of surgery, patients will be in a cast and not be able to put weight on the foot for 6 weeks, followed by 6 weeks in a walking boot.  Physical therapy may be needed to strengthen the foot and ankle and help regain ability to walk.  Return to maximal function, running, and sports can take about one year. 

Outcome 

The outcome for Lisfranc injuries depends on the severity of the injury. Some patients will not be able to return to their preinjury level of function or athletics even with well-performed treatment.  The cartilage joint surfaces are commonly injured in these injuries and may lead to foot arthritis of the middle of the foot.  It is common that after this injury, pain will persist in these joints and on some occasions, additional surgery such a fusion (gluing together of the joints) may be necessary to relieve pain. 

Complications

​Lisfranc injuries may result in arthritis and chronic pain in the middle of the foot.  This may require additional surgery.  With surgery, injury to the nerves and tendons may occur.  Because of the swelling that often occurs with this injury, wound opening, infection and/or further swelling of the foot may occur after surgery.​ 

Frequently Asked Questions

Additional Resources

​The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find an Orthopaedic Foot & Ankle Surgeon" tool at the top of this page or contact your primary doctor.