Lisfranc Injury: The Midfoot Injury That's Easy to Miss
A Lisfranc injury is an injury to the joints and ligaments in the middle of your foot, where the long bones of the forefoot meet the midfoot. It can be anything from a mild sprain to a fracture or dislocation, and because it often looks like a bad sprain on day one, it is one of the foot injuries most likely to be missed.
It gets a fair bit of attention whenever professional footballers are sidelined by it, but you don’t need to play professional footy to do one. We see them after netball, footy, a missed step on the stairs and the occasional trampoline incident.
What is the Lisfranc joint?
The Lisfranc joint complex is the group of joints across the middle of your foot, where the five metatarsals meet the small bones of the midfoot. The key part is the Lisfranc ligament, which runs from the inner midfoot bone (the medial cuneiform) to the base of the second metatarsal. It holds that part of the arch together, a bit like the keystone in a bridge.
It is named after Jacques Lisfranc, a French surgeon from the early 1800s.
How Lisfranc injuries happen
Most sporting Lisfranc injuries happen when the foot is pointed and loaded at the same time. Common examples include:
someone landing on the back of your heel in a tackle while your toes are planted
landing awkwardly from a jump with the foot pointed
twisting over a planted forefoot, or having the foot caught as you turn
missing a step and landing on the ball of the foot
Higher-energy injuries, such as car accidents or falls from a height, can cause more severe fractures and dislocations.
Signs of a Lisfranc injury
Pain and swelling across the top and middle of the foot, rather than around the ankle bones.
Bruising on the sole of the foot. This is one of the biggest clues and should always be taken seriously after an injury.
Difficulty putting weight through the foot, especially pushing up onto your toes.
Pain when the forefoot is twisted, or when pressing on the top of the midfoot.
Pain that isn't settling a week or two after what you thought was a sprain.
Is it an ankle sprain or a Lisfranc injury?
A rolled ankle usually hurts around the outside ankle bone. A Lisfranc injury hurts further forward, through the middle of the foot. If your pain is in the midfoot, or you have bruising on the sole, get it checked rather than treating it as an ankle sprain.
Why Lisfranc injuries are often missed
Many Lisfranc injuries are ligament injuries without an obvious fracture. On a standard X-ray taken while you're sitting or lying down, the bones can sit in a normal position and the X-ray can look clear. The gap between the bones may only open up when you stand on the foot.
That is why reviews commonly report that around 20 to 40 percent of Lisfranc injuries are missed at first. If one is suspected, the usual tests are weight-bearing X-rays comparing both feet, and sometimes a CT or MRI scan.
Treatment depends on whether it is stable
Stable injuries. If the joints aren't separating, the usual approach is a moon boot, often with a period of non-weight-bearing on crutches (commonly around six weeks), followed by a gradual return to walking and a rehab program.
Unstable injuries. If the bones are separating or there is a fracture-dislocation, you'll need to see an orthopaedic surgeon, as these injuries generally need surgery to hold the joints in place.
In both cases, getting the diagnosis right early matters. A Lisfranc injury that heals out of position can lead to ongoing pain and arthritis in the midfoot.
Recovery and returning to sport
Recovery from a Lisfranc injury takes longer than most people expect. Stable injuries often take around three to four months before a return to sport, and surgical cases usually take longer. Your treating team will guide the exact timeline.
Once you are out of the boot, rehab usually includes:
Getting the foot moving again after time in the boot.
Calf and foot strength, building up to single-leg heel raises on the injured side.
Balance work, progressing from standing on one leg to uneven surfaces.
A graded return to running, hopping and change of direction, the same skills you need for netball, footy and soccer.
Footwear matters during this stage. A shoe with a firm, supportive sole, or a stiffer insert or custom foot orthotics, can reduce the load through the midfoot while it settles. For footy players, our post on choosing football boots is worth a read.
How we can help
If you've injured your midfoot, we'll assess the foot, look for the warning signs of a Lisfranc injury and, if we suspect one, organise the right imaging or a referral to an orthopaedic surgeon. Once you're out of the boot, we can guide your rehab, sort out footwear and orthotics, and help you plan your return to sport. See our sports podiatry page for more.
Not sure where your pain is coming from? Try our foot pain self-check. You can also read about other injuries we see in netball and rugby league.
Don't walk off a sore midfoot
If you've had a twist, fall or tackle and the middle of your foot is swollen, bruised underneath or hard to stand on, please don't wait for it to settle. If you can't put weight on it, see your GP, an urgent care clinic or the emergency department. Otherwise, book in with us. No referral is needed, and we have parking right outside our Albany Creek clinic.
