A Lisfranc injury is damage to the bones or ligaments in the middle of your foot, where the long foot bones meet the arch. It often gets called a sprain at first.
Up to about 1 in 3 are MISSED at the first visit.
If your midfoot is still swollen and painful a week or two after a twist, and you can’t push off through your toes, it’s worth getting it looked at again.
Recovery is slow either way. Stable injuries heal in a cast or boot. Unstable ones usually need surgery. Getting back to all your usual activities often takes SIX months to a year.
Why it gets missed
The Lisfranc joint is a group of small joints across the top of the midfoot, held together by strong ligaments.
It can be injured by a heavy crush or fall, but also by something as simple as a twist and a fall off a step, or someone landing on your heel while your foot is pointed.
- It looks like a sprain: swelling and pain on the top of the foot, which many people put down to a rolled ankle
- Normal-looking X-rays: a torn ligament doesn’t show on an X-ray, and a small shift in the bones can be very hard to see if the foot isn’t bearing weight
- People keep walking on it: low-energy injuries often hurt less at first, so they don’t get checked
- Bigger accidents: when there are other serious injuries, the foot can be overlooked
The signs that point to Lisfranc
- Bruising on the SOLE of the foot: this is a strong clue that the midfoot is involved, not just the ankle
- Pain on the top of the midfoot, not around the ankle bones
- Pain when you stand on tiptoe or push off to walk
- Pain when someone twists the front of your foot while holding the heel still
- Swelling that doesn’t settle the way a sprain should
If your pain sits around the ankle bones instead, see ankle sprain recovery.
A sprain that won’t settle, with bruising under the arch, deserves a second look.
How it’s diagnosed
- Standing X-rays: images taken while you bear weight show a shift between the bones much better than lying-down ones. If standing is too painful, they may be repeated a little later
- CT scan: shows small breaks and exactly how the bones sit. It’s often used to plan surgery
- MRI scan: shows the ligaments. It’s useful when X-rays look normal but the story and the bruising say otherwise
- Comparing both feet: a small gap is easier to spot next to the healthy side
Boot or surgery
The deciding question is whether the midfoot is STABLE, meaning the bones stay in line when the foot bears weight.
- Stable, not shifted: treated in a cast or boot with no weight on the foot for about 6 to 8 weeks, with repeat X-rays to check nothing moves. Then a gradual return to walking in a boot or a stiff insole
- Unstable or shifted: usually needs surgery. Even a small shift can lead to painful arthritis later if it heals out of place
- Screws and plates: the bones are put back in line and held while the ligaments heal. Some of the metal is often removed a few months later
- Fusion: for some injuries the surgeon joins the damaged joints together permanently. These midfoot joints move very little anyway, so many people notice little difference when walking
Your surgeon will choose based on the scans and your injury. Their plan comes first.
Recovery timeline
- Weeks 0 to 8: no weight on the foot, in a cast or boot, on crutches. Foot up as much as you can to control swelling
- Weeks 6 to 12: weight on the foot increases step by step in a boot, if X-rays look right
- Months 3 to 6: into a supportive shoe, sometimes with a stiff insole. Walking without a limp, calf and foot strength, balance work
- Months 6 to 12: most people get back to all their activities in this window. Running, jumping and sport come last
The American Academy of Orthopaedic Surgeons explains the injury, the scans and treatment in its guide to Lisfranc midfoot injury.
What to expect long term
- Some people keep an ache in the midfoot, especially after long days on their feet
- Arthritis can develop in the midfoot joints, even after good treatment. It’s more likely if the injury was missed or healed out of line
- Some athletes don’t get back to their previous level. Most people return to work, walking and recreational sport
Rehab after a midfoot injury follows a similar path to other foot and ankle fractures. See broken ankle surgery recovery for how weight bearing is built back up.
Get seen today if
- You can’t put weight on the foot after an injury
- There’s bruising on the sole of the foot after a twist or fall
- The foot looks out of shape, or is pale, cold or numb
- Swelling is severe and pain is getting worse, especially if the foot feels very tight
- Your calf is painful, swollen or warm while you’re in a cast or boot. It could be a clot
Get it checked if
- A foot sprain isn’t clearly better after one to two weeks
- You still can’t stand on tiptoe on that foot
- The midfoot aches every time you walk weeks after the injury
- The arch seems to be flattening on that side
A sprain gets better on its own. A missed Lisfranc injury usually doesn’t.