Lisfranc (Midfoot) Ligament Injury

A Lisfranc injury involves damage to the ligaments or bones in the midfoot, where the metatarsal bones connect to the tarsal bones (the Lisfranc complex). These injuries can range from mild ligament sprains to severe fractures and dislocations. Early and appropriate treatment is essential for better long-term outcomes.

What Causes a Lisfranc Injury?

Common causes include:

• Trauma, such as a fall or car accident
• Twisting injuries while the foot is flexed (common in sports)
• Heavy objects falling on the foot
• Missteps on uneven surfaces

What Are the Symptoms?

• Pain in the midfoot, especially with standing or walking
• Swelling and bruising, particularly on the top and bottom of the foot
• Difficulty bearing weight
• Visible deformity in severe cases
• Tenderness over the midfoot

How Are Lisfranc Injuries Diagnosed?

An orthopedic specialist can provide a diagnosis using:

• Physical examination of the foot
• A review of your symptoms and medical history
• X-rays to detect fractures or dislocations
• MRI or CT scans are sometimes used to assess ligament damage
• Stress tests to evaluate joint stability

How Are Lisfranc Injuries Treated?

Treatment depends on the severity of the injury. The sooner you start treatment, the more effective it will be.

Nonsurgical Treatments

• Rest, ice, compression, and elevation (RICE)
• Immobilization with a cast or boot
• No weight-bearing activity for several weeks
• Physical therapy to restore mobility
• Gradual return to activity

Surgical Treatments

Surgery may be necessary for more severe injuries, especially if the bones are misaligned or the ligaments are completely torn. These procedures include:

• Open reduction and internal fixation (ORIF): Realigns bones and stabilizes them with small plates or screws.
• Midfoot fusion: Permanently joins certain midfoot bones with small plates and screws. Sometimes, both fixation and fusion are used in different bones in the same patient at the same time.

What Are the Risks?

As with any surgery, Lisfranc surgery carries some risk of complications, including:

• Infection
• Nerve or blood vessel damage
• Nonunion or malunion of bones
• Chronic pain or arthritis
• Additional surgery, such as hardware removal

What Is Recovery Like?

Your recovery depends on several factors, including your age, overall health, and how well you stick to your rehabilitation plan. For more severe injuries:

• First 6–8 weeks: No weight-bearing activity; you will wear a cast or boot
• 8–12 weeks: Gradual transition to weight-bearing activities with support
• 3–6 months: Physical therapy to regain strength and motion
• 4-6 months: Full return to normal activities

What Is the Outlook for Lisfranc Surgery?

Most patients recover well with restored stability and function, although recovery can be lengthy. Some people do experience residual stiffness or discomfort, but many patients are able to return to their normal activities.