Foot Injury Guide
Lisfranc Injury: The Basics
A Lisfranc injury involves disruption of any combination of one or more tarsometatarsal joints — ranging from mild sprains to complete fracture-dislocations.
These injuries typically affect the 2nd tarsometatarsal joint and require prompt assessment. Missed or undertreated Lisfranc injuries can lead to chronic pain, instability, and post-traumatic arthritis. The earlier you get it assessed, the better the outcome.
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How Lisfranc Injuries Present
Patients typically experience pain, swelling throughout the midfoot, and difficulty weight-bearing. Accurate diagnosis requires understanding the mechanism of injury — a significant force is usually involved.
Low-velocity sports injuries
Sprains, twists, and falls during athletic activity
High-velocity incidents
Motor vehicle accidents, falls from height, and crushing injuries
Traumatic crashes
Severe impact events causing significant structural damage
Immediate Response Steps
✓What To Do
Seek Podiatric Assessment Immediately
Prompt assessment is critical for proper diagnosis and to prevent complications.
Fit a CAM Boot for Off-Loading
A CAM boot protects the midfoot and allows you to mobilise while the injury is assessed.
Weight-Bear Only as Tolerated
Don't push through the pain. Let your body guide how much weight you put through the foot.
Pain Education & Reassurance
Understanding what's happening helps reduce anxiety and improves outcomes.
Consider Oral NSAIDs
If appropriate, anti-inflammatory medication can help manage pain and swelling in the acute phase.
Avoid Sport Pending Evaluation
Do not return to sport until you've been properly assessed and cleared.
✗What NOT To Do
Don't Inject with Corticosteroids
Corticosteroid injections leave the underlying instability unaddressed and can mask serious structural damage that requires proper management.
Don't Delay Therapy
Delaying treatment significantly increases the risk of post-traumatic complications including chronic arthritis and persistent instability.
Don't Ignore the Injury
Lisfranc injuries are frequently misdiagnosed as simple sprains. What seems minor can have serious long-term consequences if left untreated.
Treatment Approach
Treatment focuses on three core elements, tailored to the severity of your injury and your individual goals.
Load Optimisation
Managing essential vs. pathological loading is critical for recovery. We achieve this through:
- ✓Appropriate footwear selection
- ✓Strapping and padding
- ✓Custom orthotics
- ✓Gait training and modification
Capacity Building
Progressive strengthening to prevent deconditioning while protecting the healing structures. The midfoot needs to regain stability and strength before you can return to full activity. We design a graduated program that builds capacity safely and systematically.
Education
Pain science education empowers you through clear explanations of your injury and treatment progression. Understanding what happened, why it matters, and what comes next reduces anxiety and improves compliance with your recovery plan.
Goal Setting
Treatment plans should align with your individual objectives — whether that's avoiding surgery, returning to high-level sport, or simply walking pain-free. We prioritise pain relief while building toward your goals.
Understand your injury — what's happened, what it means, and what to expect
Set clear short-term goals — pain management, protected weight-bearing
Define medium-term milestones — restored mobility, return to daily activities
Establish long-term targets — full function, sport return, or surgical avoidance
Track progress and adjust the plan at every step of the way
Common Myths Debunked
“It's just bruising — it will resolve in weeks”
Missed Lisfranc injuries cause post-traumatic arthritis, chronic pain, and instability. What looks like a simple bruise can mask serious structural damage that requires proper management.
“Surgery is always required”
Appropriate off-loading and conservative management often avoids surgical intervention. Surgery is typically reserved for cases with significant displacement or instability that doesn't respond to non-surgical treatment.
“Imaging is mandatory for diagnosis”
Clinical reasoning and thorough examination take priority. Approximately 20% of Lisfranc injuries are initially missed on X-rays, which is why expert clinical assessment is so important.
Frequently Asked
Questions.
What is a Lisfranc injury?
+A Lisfranc injury involves disruption of any combination of one or more tarsometatarsal joints — the joints that connect the midfoot to the forefoot. These injuries range from mild ligament sprains to complete fracture-dislocations, and they typically affect the 2nd tarsometatarsal joint.
How do I know if I have a Lisfranc injury?
+Common signs include pain and swelling across the midfoot, difficulty bearing weight, and bruising on the bottom of the foot. If you've had a significant mechanism of injury (a twist, fall, or impact) and can't put weight on your foot comfortably, seek assessment promptly. Note that about 20% of Lisfranc injuries are missed on initial X-rays.
Do all Lisfranc injuries need surgery?
+No. Many Lisfranc injuries can be managed conservatively with appropriate off-loading, a CAM boot, progressive strengthening, and careful monitoring. Surgery is typically reserved for injuries with significant joint displacement or instability that doesn't respond to non-surgical treatment.
How long does recovery take?
+Recovery varies significantly depending on the severity of the injury. Mild sprains may recover in 6-8 weeks with proper management, while more severe injuries (fracture-dislocations) can take 3-6 months or longer. Your treatment plan will include clear milestones and regular progress reviews.
Can I return to sport after a Lisfranc injury?
+In most cases, yes — but it requires a graduated, carefully managed return. Rushing back too soon increases the risk of re-injury and long-term complications. We'll set sport-specific goals and build a return-to-play program that gets you back safely.
Don't let a Lisfranc injury go unchecked.
Early assessment prevents long-term complications. Book in with our expert podiatry team today for a thorough evaluation and personalised treatment plan.
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