# Lisfranc injury

> A Lisfranc injury is damage to the ligaments or bones in the middle of the foot, around the arch. It's often mistaken for a sprain, so a painful, swollen midfoot after an injury needs proper assessment. Stable injuries can heal in a cast; unstable ones usually need surgery.

Guide in [Heel and arch pain](https://footanklelowerlimb.com.au/learn/topics/heel-and-arch-pain), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/lisfranc-injury
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 27 October 2026.
Next review by 27 October 2027.

- **It's an injury to the middle of the foot:** the ligaments or bones around the arch are stretched, torn or broken.
- **It's easy to mistake for a sprain,** and a normal X-ray doesn't rule it out.
- **Treatment depends on stability:** steady injuries can heal in a cast, while unstable ones usually need surgery.
- **Early assessment matters,** because missed injuries can lead to long-term pain and arthritis.

## 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 bones [1]. It ranges from a ligament sprain to a break involving the bones and joint surfaces [2].

It's uncommon, but it's often diagnosed late, and that can lead to persistent pain, arthritis and loss of function [3]. 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 twisted [4]. A heavy blow or crush to the top of the foot can also cause one [4].

Many follow low-energy events such as a simple trip or fall, while some follow high-energy trauma such as a car crash [5]. They happen in all adult age groups [5]. Men are two to four times more likely to be injured, and the injury is increasingly seen in athletes [6]. 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 swelling [1]. Some people feel or hear a "pop" when it happens [7]. 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 walk [6]. That's one reason it's sometimes mistaken for a sprain [1].

Bruising on the sole of the foot is a standout sign [8]. A clinician will press on the midfoot, squeeze it and gently move the joints to check [7]. 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 remains [4]. A normal X-ray doesn't rule it out [9]. 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 bearing [10]. Unstable or displaced injuries usually need surgery [4], because getting the joint back into its exact position is the main factor in how well you do [3].

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 prevention [1][9]. 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 needed [11]. 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 operation [3]. Both approaches are considered acceptable [3]. 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 position [3] and on catching the injury early [6]. 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-dislocations [6]. 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.

## When to see a podiatrist

See your GP soon if:

- you have midfoot pain and swelling after a twist, fall or crush, even if the injury seemed minor, or it isn't settling;
- there's bruising or blistering on the sole of your foot.

See your GP or a podiatrist the same day if, after an injury:

- you can't put weight on your foot or walk more than a few steps, even if an X-ray looked normal [12];
- you heard a crack when it happened [12];
- your foot or toes feel numb or burning [13];
- your calf is hot, swollen and painful.

For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic.

Go to the nearest emergency department if your foot is badly out of shape or points at an odd angle, your toes look blue or white, or your foot is very swollen and tight [14][13].

Call 000 and ask for an ambulance if a bone comes through the skin, your foot suddenly turns cold and pale or blue with pain or numbness, or you have chest pain, sudden severe breathlessness or cough up blood while your foot is in a cast or boot.

> [!see] If you have diabetes or reduced feeling in your feet
> See your GP or a podiatrist promptly after any foot injury. See them the same day if there's a wound, sore, blister or colour change on your foot.

## Common questions

### Can I walk on a Lisfranc injury?

With a subtle injury you may still be able to walk, which is one reason it gets missed. Being able to walk doesn't rule an injury out. Keep weight off a painful, swollen midfoot until it's been examined. Once an injury is confirmed, don't put weight through the foot until your foot and ankle team says you can.

### When can I return to sport after a Lisfranc injury?

It depends on whether the injury is stable, how it's treated and how your foot responds, so it's best to ask your foot and ankle team about your own foot. Following their weight-bearing instructions and keeping your follow-up appointments comes first, and they can tell you when it's safe to build back up.

### How is a Lisfranc injury different from a midfoot sprain?

A midfoot sprain is a stretch or tear of ligaments around the arch. A Lisfranc injury can be just that, but it can also include broken bones or a joint that has moved out of place, which changes the treatment. That's why a painful midfoot is worth examining and imaging rather than treating as an ordinary sprain.

## Further reading

- [Lisfranc injury on Clindice](https://clindice.com/lisfranc-injury)
- [Lisfranc fracture | Fracture Clinic | Royal Cornwall Hospitals NHS Trust](https://fractureclinic.royalcornwallhospitals.nhs.uk/foot-injuries/lisfranc-fracture/), NHS
- [Midfoot problems](https://www.chelwest.nhs.uk/your-visit/patient-leaflets/surgery-services/midfoot-problems), NHS
- [Guidelines for management of confirmed or suspected Lisfranc injuries in ED](https://www.gloshospitals.nhs.uk/media/documents/Foot_Lisfranc_injuries_TFPIf8X.pdf), NHS

## Sources

1. Lisfranc fracture · Royal Cornwall Hospitals NHS Trust. https://fractureclinic.royalcornwallhospitals.nhs.uk/foot-injuries/lisfranc-fracture/
2. Lisfranc injuries · Welck MJ, Zinchenko R, Rudge B · Injury · 2015. https://doi.org/10.1016/j.injury.2014.11.026
3. Does Open Reduction and Internal Fixation versus Primary Arthrodesis Improve Patient Outcomes for Lisfranc Trauma? A Systematic Review and Meta-analysis · Smith N, Stone C, Furey A · Clinical Orthopaedics and Related Research · 2016. https://doi.org/10.1007/s11999-015-4366-y
4. Diagnostic evaluation and nonoperative management of Lisfranc injuries in athletes · Semelsberger SD, Boggiano VJ, Webber K et al. · Knee Surgery, Sports Traumatology, Arthroscopy · 2026. https://doi.org/10.1002/ksa.70244
5. Epidemiology, classification, and treatment of 2084 Lisfranc injuries: An observational study from the Swedish fracture register · Juto H, Mukka S, Wolf O et al. · Injury · 2025. https://doi.org/10.1016/j.injury.2024.112036
6. Lisfranc fracture-dislocations: current management · Moracia-Ochagavía I, Rodríguez-Merchán EC · EFORT Open Reviews · 2019. https://doi.org/10.1302/2058-5241.4.180076
7. Lisfranc Dislocation · Stern JM, Bergman R, Singh S · NCBI Bookshelf · 2023. https://www.ncbi.nlm.nih.gov/sites/books/NBK448147/
8. Updates on Lisfranc Complex Injuries · Yan A, Chen SR, Ma X et al. · Foot & Ankle Orthopaedics · 2021. https://doi.org/10.1177/2473011420982275
9. Guidelines for management of confirmed or suspected Lisfranc injuries in ED · NHS. https://www.gloshospitals.nhs.uk/media/documents/Foot_Lisfranc_injuries_TFPIf8X.pdf
10. Lisfranc Injuries: Latest Updates on Diagnostics and Management · Hammad A, Ahmad Y, Abdelnour J · Translational Sports Medicine · 2026. https://doi.org/10.1155/tsm2/3933956
11. Missed Lisfranc injuries-surgical vs conservative treatment · Singh A, Lokikere N, Saraogi A et al. · Irish Journal of Medical Science · 2021. https://doi.org/10.1007/s11845-020-02364-7
12. Sprains and strains · NHS. https://www.nhs.uk/conditions/sprains-and-strains/
13. Broken ankle · NHS. https://111.wales.nhs.uk/encyclopaedia/b/article/brokenankle
14. Ankle or foot injury (acute) · NSW Government. https://www.health.nsw.gov.au/outpatients/referrals/Pages/foot-injury-adult.aspx

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This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.