Lisfranc injury

What is a Lisfranc injury?

A Lisfranc injury (also called a tarsometatarsal joint injury) is damage to the ligaments or bones in the middle of your foot, around the arch, where the long foot bones meet the midfoot bones¹. It ranges from a ligament sprain to a break involving the bones and joint surfaces².

It's uncommon, but it's often diagnosed late, and that can lead to persistent pain, arthritis and loss of function³. Most of what's known comes from adults, so it isn't clear yet how common it is in children.

What causes it, and who gets it?

Lisfranc injuries often come from your weight driving down through a foot that's pointed downwards, or from twisting, such as a fall with your foot twisted⁴. A heavy blow or crush to the top of the foot can also cause one⁴.

Many follow low-energy events such as a simple trip or fall, while some follow high-energy trauma such as a car crash⁵. They happen in all adult age groups⁵. Men are two to four times more likely to be injured, and the injury is increasingly seen in athletes⁶. If you twist your midfoot or trip and land awkwardly, take midfoot pain and swelling seriously, even if the injury seemed minor.

What does it feel like, and how is it diagnosed?

It usually causes pain in the midfoot or top of the foot that's worse when you walk or stand, with swelling¹. Some people feel or hear a "pop" when it happens⁷. A severe injury can leave the foot misshapen and unable to take weight, but a subtle one often looks normal and you may still be able to walk⁶. That's one reason it's sometimes mistaken for a sprain¹.

Bruising on the sole of the foot is a standout sign⁸. A clinician will press on the midfoot, squeeze it and gently move the joints to check⁷. X-rays taken while you stand, of both feet, are the usual first step. They can miss the injury, so a CT or MRI scan is used if suspicion remains⁴. A normal X-ray doesn't rule it out⁹. Tell the clinician about any bruising on the sole and any pop.

What helps first?

A suspected Lisfranc injury needs assessment and care from a doctor or foot and ankle clinician from the start, not home treatment as for a simple sprain. Until it's assessed, keep weight off the foot.

Treatment depends on whether the joint is stable. Stable injuries where the bones haven't shifted can be treated without surgery, typically with about 4–6 weeks in a cast without putting weight on the foot, then a gradual return to weight bearing¹⁰. Unstable or displaced injuries usually need surgery⁴, because getting the joint back into its exact position is the main factor in how well you do³.

Time in a cast or boot raises the risk of a blood clot in the leg (deep vein thrombosis), which can be life threatening if untreated, so ask your team about prevention¹⁹. Don't put weight through a confirmed injured foot until they say you can.

What helps if that isn't enough?

If an injury was missed and healed badly, leaving a painful, misaligned joint or one that stays out of place, a later fusion operation (arthrodesis) may be needed¹¹. For ongoing pain, it isn't clear yet how much non-surgical options such as orthoses, injections or physiotherapy help, so talk through the choices with your team.

If you're offered surgery to fix the bones in place, ask about the chance of having the hardware removed later. That happens more often than after a primary fusion, where the joint is fused at the first operation³. Both approaches are considered acceptable³. If midfoot pain, swelling or a change in foot shape continues, go back to your foot and ankle team or GP rather than waiting.

What affects recovery?

How well you recover depends most on getting the joint back into its exact position³ and on catching the injury early⁶. Injuries that are missed or not treated well can lead to ongoing pain, deformity, an unstable foot and arthritis, which can affect up to half of fracture-dislocations⁶. Follow your team's weight-bearing instructions and keep your follow-up appointments. It isn't clear yet how long full recovery takes or what helps prevent a repeat injury, so ask your team what to expect for your own foot.