Lisfranc Injury
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
A Lisfranc injury is damage to the ligaments (strong bands that hold bones together) or bones in the middle of your foot, around the arch. It is uncommon, about 0.2 per cent of all fractures, and it is often missed at first because it can look like a sprain. The main symptoms are midfoot pain that is worse when you put weight on the foot, and swelling. Bruising on the sole of the foot is a key sign. Getting the right diagnosis early, and having the bones held in exactly the right position, gives the best chance of a good recovery.
What is it?
A Lisfranc injury is damage to the ligaments or bones in the middle of your foot, around the arch. It happens where the long bones of your foot (the metatarsals) meet the bones in the middle of your foot. The injury is usually centred on the joint at the base of the second long foot bone.
It covers a wide range. At the mild end it is a ligament sprain after a minor or sporting injury. At the severe end it is a fracture-dislocation, where bones are broken and pushed out of place.
It is uncommon, making up about 0.2 per cent of all fractures. It is also often missed or found late, which can lead to a poorer recovery.
Who does it affect?
Men are injured 2 to 4 times more often than women. The injury is common in the third decade of life (your twenties), and it is being seen more often in athletes. It has been found in all adult age groups.
These figures are for adults. Don't assume they apply to children.
Signs and symptoms
The usual signs are pain in the middle of your foot, swelling, and tenderness over the midfoot or the top of your foot. The pain is typically worse when you walk or stand.
A severe injury can leave the foot out of shape, and you may not be able to walk at all. A subtler injury often looks normal, apart from pain and swelling, and you may still be able to walk. Some people feel or hear a "pop" in the midfoot when it happens. The pain can ease after the first few steps, which can make the injury seem minor.
Bruising or blistering on the sole of your foot is the standout sign. Bruising may also show on the top of the foot. Bruising on the sole together with midfoot pain when you put weight on the foot strongly suggests a Lisfranc injury.
What causes it?
Most Lisfranc injuries come from force that travels through the foot, such as a fall with the foot twisted, or a twist while your foot is pointed down. Direct force can also cause one, for example a crush injury or a heavy blow to the top of the foot.
They can follow high-energy trauma, such as a traffic accident or a fall from a height. But many follow low-energy events. A simple trip or fall is the most common single cause (31 per cent), and about 1 in 5 injuries come from high-energy trauma. Sport injuries and missing your footing can cause one too.
How is it diagnosed?
Your practitioner will ask how the injury happened and look for swelling and bruising, especially on the sole. They will press over the joints in the middle of your foot and see whether you can stand on your toes or put weight on the foot. They may squeeze your midfoot from side to side, or gently move one of the long foot bones while holding the midfoot still (the piano key test). These tests check whether the joint is unstable.
The usual first scan is an X-ray taken while you stand on the foot, with both feet imaged so the injured side can be compared with the other. A normal X-ray does not rule out a Lisfranc injury. If your pain continues, a CT scan or an MRI scan can show damage that the X-ray missed, including damage to the ligaments.
Treatment
Treatment depends on whether the injury is stable (the bones are still in place) or unstable (the bones have moved or could move).
Looking after it at home
A suspected Lisfranc injury should not be treated as a simple sprain at home. Keep weight off a painful, swollen midfoot and have it examined promptly.
If an injury is confirmed, don't put weight through the foot until your foot and ankle team says you can. While your foot is immobilised, you have a higher risk of deep vein thrombosis (a blood clot in the leg), which can be life threatening if it isn't treated. Ask your team about preventing blood clots.
Treatment from your podiatrist
Your podiatrist can examine your foot and work with your foot and ankle team. A confirmed injury is looked after by that team, who decide whether you need urgent surgery or more tests.
If your injury is stable and the bones haven't moved, you can usually avoid surgery. You will usually wear a cast and keep all weight off the foot for 4 to 6 weeks. After that you gradually start putting weight on it again. For a stable ligament sprain, a plaster boot with no weight on the foot for six weeks is another approach.
Other options
If an injury was missed and the bones healed in the wrong position, or a joint stays out of place, you may need a second operation to fuse the joint (join the bones so they heal as one). It isn't clear yet how well other options such as shoe inserts, injections or physiotherapy relieve ongoing pain.
Surgery
Injuries where the bones have moved, or where the joint is unstable, need surgery. The aim is to put the bones back in exactly the right position and hold them firmly there. This is the most important factor in how well you recover.
There are two main operations. In one, the bones are put back in place and held with metal hardware. In the other, the joint is fused. Both are acceptable choices. Which gives better function and less pain isn't clear yet. Hardware is more likely to need removing later after the first operation than after fusion, so ask your surgeon about this before you decide.
Recovery
How well you recover depends mostly on two things: how early the injury is found, and whether the bones end up back in exactly the right position.
Injuries that are missed, found late or not treated properly can lead to long-term pain, a change in the shape of the foot, a foot that feels unstable, and arthritis in the injured joints. Arthritis can develop in up to half of fracture-dislocations that are missed or not treated properly. Finding and treating the injury early lowers these risks.
Follow the weight-bearing instructions from your foot and ankle team, and keep your follow-up appointments.
Preventing it
It isn't clear yet how to prevent a Lisfranc injury or stop it coming back. What does help is not leaving a painful, swollen midfoot after an injury. Getting it checked early prevents longer-term problems.
When to see a podiatrist
When to book
Book an appointment with your podiatrist if you have midfoot pain or swelling after a twist, fall or crush injury and it isn't settling. Also book if pain or swelling continues after your recovery, or if your foot changes shape or feels unstable.
When to get help sooner
Call your local emergency number if your toes look blue or white, if your foot is severely swollen and tight with severe pain (pressure can build up inside the foot), or if you have an open wound with bone, tendon or joint showing.
This needs urgent medical assessment: see your GP today, or go to an urgent care clinic or the nearest emergency department. Go if you can't put any weight on your foot or can't walk more than a few steps, if you heard a crack when you were injured, or if your foot looks out of shape or points at an odd angle. Go too if you have numbness or burning in your leg, foot or toes, or bruising or blistering on the sole of your foot with midfoot pain when you stand on it. If you have diabetes or reduced feeling in your feet, get prompt assessment after any foot injury.
Frequently asked questions
Is a Lisfranc injury just a bad sprain?
It can look just like one, and it is sometimes mistaken for one. A sprain usually settles. If your midfoot still hurts too much to put weight on after simple pain relief, ask for a closer look, even if your foot X-ray was normal.
Will I need surgery?
It depends on whether the joint has moved. Injuries where the bones have a gap of less than 2 mm between them, and which are stable, can usually be treated in a cast. A displacement of 2 mm or more is widely accepted as a reason for surgery. Your foot and ankle team decides after your scans.
When can I get back to sport or work?
How long this takes isn't clear yet, and it depends on the injury and the treatment you need. Don't return to sport or work until your foot and ankle team agrees. Keep your follow-up appointments so they can guide each step.
Can I do foot exercises while I recover?
Only if a healthcare professional has given them to you, or has said they are safe for your injury. Check with them first. Stop straight away if an exercise causes pain or you start to feel unwell.