Lisfranc Fracture Overview

A Lisfranc injury affects the midfoot, specifically the joints where the long bones of the foot (metatarsals) meet the small bones of the midfoot (tarsals). These joints form the arch of the foot and play a crucial role in weight-bearing and stability.

Injuries to this area can involve:

• Fractures

• Ligament tears

• Or both

Prompt diagnosis and treatment are essential to avoid long-term problems such as joint collapse or arthritis.

Lisfranc Fracture Symptoms and Diagnosis

Symptoms typically include:

• Pain and swelling in the midfoot (especially after injury or twisting)

• Inability to bear weight

• Bruising on the sole of the foot (a key sign of Lisfranc injury)

• Pain that worsens with walking or standing

• Visible foot deformity in severe injuries

Diagnosis is confirmed by X-rays, often with weight-bearing views. If unclear, a CT scan or MRI may be used to assess subtle joint damage or ligament injury.

Lisfranc Fracture Causes

• High-energy trauma such as a car accident or fall from height

• Twisting injuries (e.g. stepping into a hole while the foot is flexed)

• Crush injuries to the foot

• Sports injuries (especially contact sports or equestrian activities)

Lisfranc Fracture Treatment and Prevention

Non-Surgical Treatment

Only appropriate for stable, non-displaced injuries. Treatment involves:

• Non-weight-bearing in a cast for six weeks

• Transition to a walking boot with gradual return to activity

• Arch support or orthotics to reduce pressure on the midfoot

Surgical Treatment

Most Lisfranc injuries require surgery due to joint displacement or instability.

Surgical options include:

• Open reduction and internal fixation (ORIF) using screws and/or plates to realign and stabilise the joints

• In some cases, especially if joints are severely damaged, fusion surgery may be considered

Lisfranc Surgery

Surgery is performed under general anaesthetic. Incisions are made over the top of the foot, and the bones are realigned and fixed into place. Sometimes the screws are left in place, while in other cases they may be removed later.

Risks of surgery may include:

• Pain

• Bleeding

• Infection

• Scarring

• Nerve or blood vessel injury

• Deep vein thrombosis (DVT) or pulmonary embolism (PE)

• Stiffness or arthritis in the midfoot

• Failure to improve symptoms

• Need for further surgery

Lisfranc Surgery Recovery

After surgery, you will be placed in a cast and remain non-weight-bearing for six weeks. This allows the bones and joints to heal in their corrected position.

Following cast removal, you will gradually transition to protected weight-bearing in a walking boot, along with physiotherapy to restore movement and strength.

To support the arch and reduce long-term joint stress, most patients require a lifelong medial arch support or custom orthotic to help prevent late collapse or arthritis.

Expected Recovery Timeline

0–6 weeks

Non-weight-bearing in cast. Foot elevated. Rest and healing.

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 activity including sports if healing is complete and pain is manageable.