Lisfranc injuries of the midfoot are not common injuries, but when they do happen they are often missed or misdiagnosed.
They are caused by high-energy events like motor vehicle accidents, falls from heights, or crush injuries.
While recovery from a Lisfranc injury is often quite successful, concerns often arise about treatment options: how long does it take to recover? Tips to help with pain? When to resume sports? Is orthopaedic support necessary?
As a diagnostic radiographer, I’m addressing your most frequently asked questions about the duration and steps to take! Based on my knowledge.
Towards the end of the article, you’ll also find references to the scientific publications I rely on. And there’s a comment section if you have any questions or remarks!
Happy reading!😀 and feel free to ask questions in the comments or share your own experience.🙏
Last updated: July, 2025. Written by Juliet S, a diagnostic radiographer.
▶️ What is a Lisfranc (midfoot) fracture dislocation?
Lisfranc (midfoot) fracture injuries result if bones in the midfoot are broken, dislocated or ligaments that support the midfoot are torn.
The term “Lisfranc injury” strictly refers to an injury where one or more of the metatarsals are displaced from the tarsus.
The term is more commonly used to describe an injury to the midfoot centred on the 2nd tarsometatarsal joint.
The severity of a Lisfranc injury can vary widely. Patients who come for x-ray. Some of them have a simple injury involving one midfoot joint while some may have a complex injury involving many midfoot joints and broken bones.
These types of fracture rare and account for 0.2% of all fractures (Mascio,2022)
▶️What does a Lisfranc fracture look like on x-ray
Image source By James Heilman, MD -wikimedia.org
▶️What are the three types of Lisfranc fracture classification?
The classification of Lisfranc injuries was originally described by Quenu and Kuss in 1909 based on the three-column concept.
1️⃣Type A: injury all the metatarsals are displaced in one direction, and there is total incongruity.
2️⃣Type B: injury consists of partial incongruity with one or more metatarsals displaced.
3️⃣Type C: injury shows a divergent pattern of incongruity
Hardcastle,1982
Image showing different types of Lisfranc fractures (Image from Moracia-Ochagavía,2019)
A further modified classification system accounting for the complexity of the injuries
In which previous type B and type C injuries were subdivided into B1, B2, C1 and C2
🟣In which Type B1 injuries there is isolated medial dislocation of the first metatarsal.
🟣In B2 there is isolated lateral dislocation of the second to fifth metatarsals.
🟣Type C1 injury is a divergent injury of some of the tarsometatarsal joints.
🟣C2 is a divergent injury of all the tarsometatarsal.
Prompt and accurate diagnosis is crucial to prevent long-term complications.
▶️How can I be sure it’s a Lisfranc fracture and not something else? (symptoms)
The symptoms of Lisfranc fractures are similar to those of other foot problems that can occur following a shock or accident.: simple contusion, sprain, tendonitis, fracture from another bone.
These are the common symptoms you may experience:
🔴You will feel significant pain and swelling in the midfoot, bruising on the top or bottom of the foot.
🔴Pain with a “piano key” test. The doctor may grasp your toes and move them up and down to determine whether this causes you pain.
🔴Your pain will worsen when you try to weight-bear.
🔴It will be tender to the touch over the tarsometatarsal joints
🔴Foot deformities.
Image from: Moracia-Ochagavía,2019
These symptoms are key findings that will give the doctor examining you a guess.
But further imaging x-rays will be done to confirm the diagnosis because even a simple Lisfranc injury can be easily mistaken for a sprain, especially if the injury is a result of a straightforward twist and fall.
Up to 20% of Lisfranc fractures are unnoticed or diagnosed late leading to long-term complications like midfoot instability, arch collapse, and post-traumatic arthritis. (Mascio,2022)
Caution! injury to the Lisfranc joint is not a simple sprain that should be “walked off” or expected to heal quickly
To be sure the bones are broken, and to see exactly what the fracture is, (whether it is displaced or not) your doctor will take an x-ray of the foot.
➡️The X-ray allows you to visualize the extent of the fracture.
➡️But a computed tomography (CT) scan allows a more accurate assessment of the Lisfranc joint.
➡️ Magnetic resonance imaging (MRI) is very useful for detecting soft tissue injuries and ligamentous injuries.
These 3 examinations allow you to be almost certain of not missing a fracture.
A CT scan showing a Comminution of the cuneiforms and bases of the metatarsal fractures. Increased space between the first and second metatarsals, and fracture-avulsion of the Lisfranc ligament (Image from Moracia-Ochagavía,2019)
▶️Can I ignore a Lisfranc fracture?
It is very important to see a doctor as soon as you think you have injured your foot, and you have the listed symptoms.
Quick identification and management of Lisfranc injuries is crucial to help:
➡ ️ Reduce risk of progressive midfoot instability and arch collapse.
➡Forefoot abduction.
➡ ️Post-traumatic osteoarthritis (OA) that can result in stiffness, chronic pain, and dysfunction of the foot and ankle complex.
➡ ️ And a speedy recovery.
Source: Welck,2014
▶️What is the usual treatment for Lisfranc foot injuries?
Management of Lisfranc injuries depends on the severity of the injury, with the primary goals of treatment being pain relief and foot stability preventing later osteoarthritis and disability.
As with most fractures, there are two main types of treatment for Lisfranc fractures:
1️⃣conservative treatment: no operation, but instructions for immobilisation or less weight bearing and a follow up appointment.
When your doctor confirms that your fracture is stable and not displaced for example it is just a sprain of the Lisfranc joint and stress views are not displaced.
⚪Then you will be given a non-weight bearing short leg cast for 6 weeks.
⚪If at 6 weeks the pain persists, an orthopaedic boot with weight-bearing is used for 4 more weeks
⚪After this period, if the midfoot pain disappears, physical activity can be gradually resumed using an orthopaedic insole to discharge the medial longitudinal arch.
⚪Compression socks and insoles were recommended and greatly appreciated by patients who used them (Van 2022).
Here is a review from one of the patients who used compression socks.
I called the doctor because my leg was swelling, and she gave me a compression sock. This helped a lot, it also provided support.’ – F, age 67, >12 months post-PA
⚪ Footwear insoles provide a steady progress during recovery, it reduces the pain, which makes walking and exercising easier (Van 2022).
Here is a review from one of the patients who used footwear insoles:
‘I have insoles now, fitted to my foot. And they also advised me to buy shoes with a sturdy sole. This provides a lot of support, and my feet can rest a lot more’ – M, age 58, >12 months post-ORIF
So, you can try these methods yourself, if they work for you, better for your recovery.
2️⃣Surgical treatment.
Surgical options:
Surgical intervention is recommended for more severe Lisfranc injuries, especially if conservative treatment is not effective.
The objective of the surgery is to achieve anatomical reduction, which helps restore articular function.
Here are the types of surgical procedures I see in theatre for Lisfranc injuries.
⚪Open reduction and internal fixation (ORIF) with trans articular screws or with dorsal plates in cases of comminution of metatarsals or cuneiform bones is applied.
Image E, an On X-ray before surgery, fracture-dislocation was observed at the left Lisfranc joint. Image f1-f3 different x-ray views after surgery (mage source: Qu et al 2016)
⚪Primary fusion (joint arthrodesis) is a surgical procedure where two bones in a joint are fused together to eliminate movement and pain.
where the risk of post traumatic arthritis is high, joint arthrodesis is recommended ,though it is very rare.
There is a risk of infection after surgery but you will be given routine antibiotics to help prevent infection.
▶️How long pain can persist after surgery?
Pain has been identified as a common factor after treatment and during the recovery period.
What kind of pain are we talking about, pain after treatment that persists more than 6 months.
⚪You will have initial pain and swelling that can last 3-6 months which is very normal, with swelling worsening at the end of the day.
⚪Persistent pain and stiffness after the fracture even after the fracture has healed and the initial recovery period has passed.
⚪Chronic pain caused by arthritis in the affected joint.
A review that was done by (van et al 2022), on patients who were recovering from Lisfranc fracture injuries had this to say about pain.
Some patients were under the impression that the pain would disappear or at least be reduced after the cast was removed but were then surprised that the pain level increased.
Jane had this to say: When the walking cast came off, I thought I could just walk home in a supportive shoe, but I was very disappointed. It was very painful, and I made progress very slowly.
▶️How to manage this kind of pain while at home.
⚪Pain medication: you will be given pain medication by your doctor before discharge, speak to your doctor if your think it is not working.
⚪Elevation of your leg: Try to elevate your leg, it will help reduce swelling and resting your feet will reduce pain.
⚪Apply ice to the affected feet, it helps cool down the pain.
⚪ Bracing support: Wearing a brace or orthotic support can help stabilize the foot and reduce stress on the injured area.
⚪Activity modification: Gradually increasing activity levels and avoiding activities that cause pain is essential for a safe return to normal function.
⚪Wear supportive footwear: Wearing supportive and well-fitting shoes can help protect the foot and reduce pain.
⚪Wear compression stockings to help with swelling and blood circulation.
Adored to your regular follow-up appointments with an orthopaedic specialist are crucial to monitor healing, address any concerns such as pain, and adjust the rehabilitation plan as needed.
▶️What are the long-term effects of a Lisfranc fracture?
Lisfranc fractures can lead to long-term complications like chronic pain, arthritis, and altered gait, even after successful treatment.
🔴Some individuals may experience persistent discomfort, limited mobility, and a reduced ability to participate in activities like before.
🔴Many individuals with Lisfranc injuries experience chronic pain in the midfoot, which can significantly impact daily life.
🔴Lisfranc injuries can lead to post-traumatic arthritis caused by the cartilage damage that occur during the initial injury, especially in cases of severe injury or incomplete healing.
🔴Injuries to the Lisfranc joint can affect the way you walk, leading to an altered gait or a limp. This can be due to pain, instability, or muscle weakness in the foot and ankle.
🔴Foot deformity and nerve damage during the injury due to numbness, tingling or pain.
🔴Hardware problems: There may be the need to remove the screws, articular damage to the involved joints after years of surgery.
🔴The potential for screw breakage, hardware removal can be difficult.
Here is another article that may be of interest to you about Hardware screw removal after years of operation.
Here are some data from studies that track people’s recovery from Lisfranc fractures (Hardcastle,1982):
Closed reduction and cast immobilization of displaced Lisfranc injuries yielded inconsistent results in a series of retrospective reviews.
🔴18 patients treated with closed reduction and casting;5 patients developed arthritis despite anatomic reduction
🔴69 patients who were treated with closed reduction found good to fair results in the subset of patients treated with closed reduction and immobilization.
🔴 20 patients treated with cast immobilization without reduction. They found generally unsatisfactory outcomes, often with resulting midfoot degenerative arthritis (Goossens,1983)
As with any fracture, complications are possible, but they are the exception rather than the rule: stiffness, residual pain, non-union fracture or necrosis of the bone.
▶️Is the physiotherapy needed with Lisfranc fractures.
A course of physical therapy will be needed after treatment both conservative and surgery.
The main reason why you may need physio is to help restore strength, flexibility and function to the foot.
After initial immobilization and pain management, physiotherapy will help you regain range of motion, building muscle strength, and improving balance.
These may include.
️ ♦️ Physiotherapy taping for Lisfranc fractures focuses on providing support and stability to the injured midfoot, promoting proper alignment, and potentially reducing pain and swelling.
♦️Applying ice is a key component of physiotherapy for Lisfranc fractures, especially in the initial stages to manage pain and swelling.
Ice helps reduce inflammation and numb the affected area, providing natural pain relief.
♦️Therapeutic Ultrasound uses high-frequency sound waves to stimulate tissue healing. It can be applied in pulsed or continuous modes, depending on the specific treatment goals.
Helps to accelerate fracture healing, reduces pain and improves blood circulation to the injured area, promoting healing.
♦️Iontophoresis is used to deliver medication, usually corticosteroids, directly into the injured tissue using a low-level electrical current.
The aim is to reduce pain, swelling, promote healing and restore function of the foot.
It’s crucial to consult with a qualified physiotherapist professional for proper physiotherapy assessment because each specific injury may require a personalised treatment plan.
▶️What is the recovery time of Lisfranc fractures?
It is important to understand that determining the actual timeline for recovery associated with Lisfranc injuries can be difficult even when you have got treatment.
There is a potential for a prolonged recovery time because of the nature of the injury.
| A minor Lisfranc injury, such as a strain, may heal in as little as 8 weeks, but most surgical repairs require at least 4 months of healing, if not a full year. |
Your orthopaedic doctor will explain to you why such injuries may take long for you to resume your normal activities.
Some patients find this frustrating, but you should be optimistic, follow your doctors’ instructions and you will be back on your feet.
Looking on the positive side, studies that followed up patients’ experience after treatment give these healing estimate timelines.
| Phase | Recovery timeline |
| Reduced pain and swelling | 3 to 6 months and it can continue to 12 months post the operation. |
| Non-weight bearing in a cast or boot | 0-6 weeks after injury |
| Transition to partial weight bearing | Around 6 -12 weeks |
| Full weight bearing | Around 2 to 6 months |
| Return to work | It will depend on the type of job you do; physically demanding & standing jobs may require 12 weeks or more before returning to full time dues. |
| Return to sports | Around 16 weeks to 12 months (Vopat,2019) |
| k-wire removal in some people | 6-8 weeks or 3-4 months, some can be removed after a year. (Qu 2016) |
| Starting physiotherapy | Sooner after the cast comes off to avoid stiffness. |
| Full recovery | 6 months to a year or even longer, depending on the severity of the injury. |
Healing times after Lisfranc fracture, whether operated or not
▶️ When to return to sports like running, football and others after treatment for Lisfranc fracture.
Lisfranc injuries can be a successful treatment in the athletic population and allow you to return to sports at close to your preinjury level of play.
Returning to sports after a Lisfranc fracture can take anywhere from several months to a year, depending on the severity of the injury and the treatment method.
If you are involved in high impact sports with pivoting and jumping, your recovery may take a longer return to sports than a low impact activity.
These are the factors that influence how quickly you can get back into sport. You’ll probably be able to get back into the swing of things more quickly if:
♦️Your fracture is not displaced or complex.
♦️You were already fit and athletic before the fracture
♦️You have not had any other fractures or problems in addition to this fracture.
♦️You have had no complications, you are progressing well, the pain is diminishing over the days and weeks.
♦️You’re keen to get back into sport, so plan to start early.
Whatever the sport, most people with Lisfranc injuries manage to get back into sport within a few months to a year.
A small retrospective study done by (Vopat et al 2019), of 11 patients who had a Lisfranc injury who were treated with surgical repair with a one-year follow-up
Here is a breakdown timeline when they were able to return to sports.
♦️ All the 11 patients were able to return to sports after 16 weeks to 1 year after treatment.
♦️8 patients returned to full competition at 80%.
♦️1 patient had a 4-month delay in treatment and attempted to return to sport but was unable to achieve full competition.
♦️ 67% of patients were still experiencing occasional pain during sporting activities with a pain level of 0 to 5.
♦️1 patient did not attempt to return to sport due to a chronic knee injury.
♦️2 athletes were not able to return to competition because one had other injuries and the other had a delay in treatment for four months.
♦️For patients who were treated nonoperatively, their average return to sport was 8 to 10 months.
Source: Vopat,2019
Other studies had these timelines:
♦️ Nonoperative treatment consisting of casting and the use of crutches for 4 to 6 weeks was successful in returning patients back to athletics, however, the time to return to competition averaged 4 months. (Shapiro,1994)
♦️I have seen some patients return to sports training after 5 months and full competition around 25 weeks after injury.
Results are based on a relatively small number of patients and data were collected retrospectively. There is a need for more studies in this case.
You should be aware that complications like arthritis or persistent pain can delay your return to sports.
| Conclusion! Most athletes can return to sport after undergoing open reduction and internal fixation of a Lisfranc injury by less than 30 weeks post-surgery. However, most of the patients also experienced some residual pain with their respective sport. These findings suggested that athletes with a Lisfranc injury can have reliably good outcomes with operative repair. |
So be patient with yourself, we all heal differently, follow your doctors’ instructions, before you know it, you will be on the road for a full recovery.
We have come to the end of this article; hope I have answered your questions. Wishing you a quick recovery!🙋
Do you have an experience to share or questions? Comment below the article!
📚Source:
Murphy A, Lisfranc injury – Myerson classifications (illustrations). Case study, Radiopaedia.org (Accessed on 27 Jun 2025) https://doi.org/10.53347/rID-99527
Moracia-Ochagavía I, Rodríguez-Merchán EC. Lisfranc fracture-dislocations: current management. EFORT Open Rev. 2019 Jul 2;4(7):430-444. doi: 10.1302/2058-5241.4.180076. PMID: 31423327; PMCID: PMC6667981.
Mascio A, Greco T, Maccauro G, Perisano C. Lisfranc complex injuries management and treatment: current knowledge. Int J Physiol Pathophysiol Pharmacol. 2022 Jun 15;14(3):161-170. PMID: 35891929; PMCID: PMC9301181.
Welck MJ, Zinchenko R, Rudge B. Lisfranc injuries. Injury. 2015 Apr;46(4):536-41. doi: 10.1016/j.injury.2014.11.026. Epub 2014 Dec 10. PMID: 25543185.
Hardcastle P, Reschauer R, Kutscha-Lissberg E, Schoffmann W. Injuries to the tarsometatarsal joint. Incidence, classification and treatment. J Bone Joint Surg Br. 1982;64-B(3):349-356. doi:10.1302/0301-620X.64B3.7096403
Crates JM, Barber FA, Sanders EJ. Subtle lisfranc subluxation: results of operative and nonoperative treatment. J Foot Ankle Surg. 2015 May-Jun;54(3):350-5. doi: 10.1053/j.jfas.2014.07.015. Epub 2015 Mar 4. PMID: 25746769.
Shapiro MS, Wascher DC, Finerman GA. Rupture of Lisfranc’s ligament in athletes. Am J Sports Med. 1994 Sep-Oct;22(5):687-91. doi: 10.1177/036354659402200518. PMID: 7810794.
Goossens M, De Stoop N: Lisfranc’s fracture-dislocations: etiology, radiology and results of treatment. A review of 20 cases. Clin. Orthop. 176: 154–162, 1983
Alberta FG, Aronow MS, Barrero M, Diaz-Doran V, Sullivan RJ, Adams DJ. Ligamentous Lisfranc joint injuries: a biomechanical comparison of dorsal plate and transarticular screw fixation. Foot Ankle Int. 2005 Jun;26(6):462-73. doi: 10.1177/107110070502600607. PMID: 15960913.
Maduka GC, Maduka DC, Yusuf N. Lisfranc Sports Injuries: What Do We Know So Far? Cureus. 2023 Nov 13;15(11):e48713. doi: 10.7759/cureus.48713. PMID: 37965234; PMCID: PMC10641664.
Qu W, Ni S, Wang Z, Zhao Y, Zhang S, Cheng Y, Liu T, Yu M, Wang D. Severe open Lisfranc injuries: one-stage operation through internal fixation associated with vacuum sealing drainage. J Orthop Surg Res. 2016 Nov 4;11(1):134. doi: 10.1186/s13018-016-0471-1. PMID: 27814724; PMCID: PMC5095961.
van den Boom NAC, Douwes I, Poeze M, Evers SMAA. Patient experiences and preferences during treatment and recovery of Lisfranc fractures: A qualitative interview study. Injury. 2022 Dec;53(12):4152-4158. doi: 10.1016/j.injury.2022.10.013. Epub 2022 Oct 18. PMID: 36273922.
Vopat BG, Vopat ML, van Dijk PAD, Hazzard S, McKinnon K, Asnis PD, Theodore GH. Return to Sport after Surgical Treatment of Lisfranc Injuries in Athletes: A Retrospective Case Series. Kans J Med. 2019 Nov 25;12(4):141-145. PMID: 31803357; PMCID: PMC6884016.
x-ray image of Lisfranc fracture: By James Heilman, MD – Own work, CC BY-SA 4.0.