Lisfranc Injuries: The Midfoot Sprain You Don’t Want to Miss
When we think of foot and ankle injuries, most people picture a rolled ankle or a broken toe. But there’s another injury that, while less common, can have a much bigger impact if it slips under the radar. The Lisfranc injury.
This type of injury affects the ligaments that stabilise the middle of the foot. If not picked up early and managed well, it can lead to long-term pain, arthritis, and difficulty returning to sport.
At SurfEdge, we see Lisfranc injuries most often in athletes, but they can also happen in day-to-day life. Here’s what you need to know.
What is the Lisfranc Joint?
The Lisfranc joint is where the long bones of the foot (metatarsals) meet the small bones in the arch (cuneiforms). These joints are held together by strong ligaments that are designed to keep the midfoot stable while allowing for powerful push-off when running, jumping, or changing direction.
A Lisfranc injury happens when those ligaments are torn or when the bones shift out of place. Injuries can range from a mild sprain to a more severe disruption where several bones are involved.
image courtesy Orthoinfo - click the picture to link to website
How Do These Injuries Happen?
Lisfranc injuries usually come from a twisting force through the foot while it’s planted. Common scenarios include:
Getting a boot stuck in the turf while the body rotates
Landing awkwardly from a jump with the foot pointed down
Falls from a height, or heavy trauma (e.g. car accidents, being stepped on by a horse)
Sometimes, the symptoms can mimic a simple ankle sprain - but pain and swelling are more focused through the middle of the foot rather than the outside of the ankle. Bruising under the arch is another red flag.
Diagnosis: Why They’re Missed
One of the tricky things about Lisfranc injuries is that standard x-rays can look normal, especially in the early stages. That’s why a good history and clinical assessment is crucial.
Things we look for in clinic include:
Difficulty weight-bearing or pushing up onto the toes
Pain with the “piano key” test (where each metatarsal is gently moved)
Midfoot swelling and bruising
If we’re suspicious, further imaging such as weight-bearing x-rays, CT, or MRI may be required. Missing the diagnosis early can mean ongoing pain, stiffness, and reduced athletic performance down the track.
Management Options
Treatment depends on how severe the injury is and whether the foot is stable.
Stable injuries (no major separation or shift between the bones) may be managed without surgery. This usually involves a period of non-weight bearing in a boot or cast, followed by a structured rehabilitation program.
Unstable injuries (where there’s obvious movement or ligament rupture) often require surgery to realign and stabilise the bones, sometimes with screws or plates. These may later be removed once the joint has healed.
Even with surgery, rehab can be a long journey. Returning to sport often takes 6–12 months, and not everyone makes it back to their previous level of play. Some people develop arthritis or ongoing midfoot pain despite good management.
Rehabilitation Phases
While every rehab plan is tailored to the individual, a typical pathway includes:
Early phase (0–6 weeks): Non-weight bearing, swelling management, keeping the rest of the body strong and conditioned.
Progressive loading (6–12 weeks): Gradual return to weight-bearing in a boot, with careful exercises to rebuild strength in the foot and ankle.
Strength and control (12–16 weeks): Transition into normal shoes, targeted strengthening of the calf and foot, and balance work.
Return to sport (4–9 months): Running, agility, and plyometric progressions, plus sport-specific drills once strength and movement criteria are met.
Along the way, input from podiatry (orthotics, footwear advice) and taping can help reduce load on the midfoot and support performance.
Key Takeaways
Lisfranc injuries are rare but serious, and they’re often missed at first.
Pain and bruising in the middle of the foot after a twisting or impact injury should be checked carefully.
Rehab is long-term and should focus not just on the foot, but the whole body.
Returning to sport is possible, but it requires patience, structured progression, and often surgical input.
If you’ve had a foot injury that doesn’t feel like “just a sprain,” it’s worth getting it assessed properly. At SurfEdge Sports Physiotherapy, we can help guide diagnosis, liaise with your medical team, and design a tailored rehab plan to get you back to doing what you love.