What Is a Lisfranc Injury?
A Lisfranc injury refers to damage to the bones, ligaments or both at the Lisfranc joint complex — the group of joints and ligaments that connect the midfoot to the forefoot. Named after a French surgeon, the Lisfranc joint is critical for foot stability, weight-bearing and propulsion during walking, running and jumping.
Lisfranc injuries range from mild ligament sprains to complete ligament tears and fracture-dislocations. They’re frequently misdiagnosed as simple sprains, which is why accurate assessment and imaging are essential. An undertreated Lisfranc injury can lead to chronic midfoot pain, instability and long-term joint damage.
Lisfranc Injury Classification
Lisfranc injuries can be classified into 3 categories:
| Sprains | The Lisfranc ligament and other ligaments on the bottom of the midfoot are stronger than those on the top of the midfoot. When weakened through a sprain (stretching of the ligament), patients experience instability of the joint in the middle of the foot. |
| Fractures | A break in a bone in the Lisfranc joint can be either an avulsion fracture (a small piece of bone is pulled off) or a break through the bone or bones of the midfoot. |
| Dislocations | The bones of the Lisfranc joint may be forced from their normal positions. |
What Causes a Lisfranc Injury?
Lisfranc injuries typically occur in two ways:
High-energy trauma — such as a direct blow to the foot, a motor vehicle accident or a heavy object falling on the foot. These often involve significant fractures and dislocations.
Low-energy or twisting injuries — a foot that twists awkwardly when planted, a misstep off a kerb or landing incorrectly during sport. These are more common in athletes and dancers and can involve purely ligamentous damage with no obvious fracture on X-ray.
Common scenarios include:
- Landing incorrectly from a jump in dance or sport
- Stumbling with the foot trapped in a fixed position
- Contact sport collisions involving the midfoot
- Falling from a height onto a plantar-flexed foot
Signs You May Have a Lisfranc Injury
Lisfranc injuries are frequently mistaken for ankle sprains or simple foot bruises. Key signs to look for include:
- Pain and swelling across the top of the midfoot
- Bruising on the sole of the foot
- Bruising and swelling on the top of the foot
- Pain that worsens with weight-bearing and improves with rest
- Instability or difficulty pushing off when walking
- A sensation that the foot has “given way”
If you’ve injured your foot and notice bruising on the sole, seek assessment promptly. This pattern is strongly associated with Lisfranc injury and warrants imaging to rule out fracture or dislocation.
How We Treat Lisfranc Injury
Lisfranc injury management depends on the severity of the injury – specifically, whether the ligaments are partially or completely torn and whether a fracture or dislocation is present. Your podiatrist will thoroughly assess the injury and coordinate imaging before recommending a treatment plan.
- Assessment and imaging — X-ray is the first-line investigation, though MRI is often required, as Lisfranc injuries are commonly missed on plain film. In some cases, weight-bearing X-rays may be needed to assess stability
- Offloading and immobilisation — a moon boot or non-weight-bearing cast to protect the joint and allow ligament healing
- Gradual return-to-weight-bearing program — a structured, staged plan to restore load tolerance through the midfoot
- Orthotics and footwear modifications — custom orthotics to support the midfoot arch and reduce stress through the Lisfranc joint during recovery and beyond
- Rehabilitation program — progressive strengthening and proprioceptive exercises to restore foot stability, strength and movement patterns before return to sport or full activity
Why Choose Highett Podiatry?
Lisfranc injuries are among the most commonly missed foot injuries and the consequences of undertreatment are significant.
Our podiatrists have experience managing Lisfranc injuries across a broad range of patients, from dancers and athletes to everyday patients who’ve sustained a midfoot twist.
We take a thorough approach to diagnosis, ensure appropriate imaging is obtained and build a rehabilitation plan tailored to your activity goals.
We offer appointments at our Highett and Mentone clinics. No referral required.