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Lisfranc Injury

Disruption of the tarsometatarsal joint complex (Lisfranc joint) ranging from subtle ligamentous sprain to severe fracture-dislocation, often missed on initial evaluation, requiring high index of suspicion, weight-bearing radiographs, and surgical fixation or arthrodesis to prevent post-traumatic arthritis.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Ortopedi ve Travmatoloji department. Book Appointment →

What is Lisfranc Injury?

Lisfranc injury refers to disruption of the tarsometatarsal joint complex (Lisfranc joint), which connects midfoot to forefoot. Named after Jacques Lisfranc, Napoleon's surgeon who described foot amputation through this joint. The Lisfranc ligament (interosseous between medial cuneiform and second metatarsal base) is critical for arch stability.

Mechanisms include direct trauma (crush injury), indirect axial loading on plantarflexed foot (sports — football, equestrian; missing step), and motor vehicle collisions. Anatomically, the second metatarsal base is recessed into the cuneiforms (keystone), with the Lisfranc ligament providing critical stability. Injury patterns range from subtle ligamentous sprain (Lisfranc ligament tear) to severe fracture-dislocation patterns (homolateral, divergent, partial).

Diagnosis is challenging — up to 20% missed initially. High clinical suspicion in midfoot pain after trauma, ecchymosis on plantar midfoot (pathognomonic plantar ecchymosis sign), inability to bear weight, midfoot swelling. Weight-bearing AP foot radiographs (essential, often missed if non-weight-bearing) showing >2 mm diastasis between first and second metatarsal bases or fleck sign (avulsion fracture from Lisfranc ligament). CT scan for subtle injuries; MRI for ligamentous-only injuries. Management: stable injuries (no displacement on weight-bearing) — non-operative cast/boot 6-8 weeks; unstable/displaced — primary surgical management with ORIF (anatomic reduction and screw or plate fixation) or primary arthrodesis (recommended for purely ligamentous injuries and severe comminuted patterns per recent evidence). Severe injuries have high rate of post-traumatic arthritis even with treatment.

Symptoms

Midfoot pain after trauma (often subtle in low-energy injuries)
Plantar ecchymosis on midfoot (pathognomonic)
Inability or difficulty bearing weight
Midfoot swelling and tenderness
Pain with passive midfoot abduction/pronation
Wide forefoot or longitudinal arch flattening (severe)

Risk Factors

Sports (football, equestrian — direct trauma or twisting)
Motor vehicle collisions
Falls from height
Crush injuries to foot
Elderly with osteoporosis (low-energy injury)
Diabetic Charcot foot (atraumatic Lisfranc disruption)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent midfoot pain after trauma
  • Plantar ecchymosis on midfoot
  • Inability to bear weight after foot injury
  • Midfoot swelling not improving
  • Suspected Lisfranc injury after foot twist
  • Failed conservative management of presumed sprain

Treatment Methods

01
Clinical examination including weight-bearing assessment, plantar ecchymosis sign
02
Weight-bearing AP, lateral, oblique foot radiographs (essential — non-weight-bearing may miss injury)
03
Look for >2 mm diastasis between first and second metatarsal bases, fleck sign
04
Comparison view of contralateral foot if subtle
05
CT scan for surgical planning and subtle bony injuries
06
MRI for purely ligamentous injuries (Lisfranc ligament status)
07
Stable injury (no displacement on weight-bearing): non-weight-bearing cast/boot 6-8 weeks, gradual return
08
Unstable/displaced injury: anatomic reduction and surgical fixation
09
Open reduction and internal fixation (ORIF): trans-articular screws (Lisfranc screw), plate fixation
10
Primary arthrodesis: increasingly favored for purely ligamentous injuries and severe comminuted patterns (better outcomes per recent meta-analyses)
11
Postoperative: non-weight-bearing 8-12 weeks, hardware removal at 4-6 months for ORIF (controversial)
12
Late complications: post-traumatic arthritis common, may require salvage arthrodesis

Which Department to Visit?

You can visit our Ortopedi ve Travmatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Lisfranc Injury (Tarsometatarsal)

Ortopedi ve Travmatoloji

Lisfranc injury is a spectrum of midfoot injuries involving disruption of the tarsometatarsal joint complex (Lisfranc joint), named after Napoleonic surgeon Jacques Lisfranc de St. Martin. The injury ranges from subtle purely ligamentous Lisfranc sprains to complex fracture-dislocations involving the second metatarsal base, medial cuneiform, and the Lisfranc ligament (between medial cuneiform and second metatarsal base). Mechanisms include direct (crush, fall on plantarflexed foot) and indirect (axial loading on plantarflexed foot, twist injuries in athletes — football, equestrian). Subtle injuries are missed in up to 20% of cases at initial presentation. Diagnosis requires high index of suspicion, weight-bearing AP/oblique/lateral foot radiographs (most sensitive — comparison with contralateral foot), and CT or MRI for occult injuries. Hardwig sign (fleck fracture between medial cuneiform and second metatarsal) is pathognomonic. Treatment is non-weight-bearing immobilization for stable nondisplaced injuries, but most require open reduction internal fixation (ORIF) with screws or plates, or primary arthrodesis for severe purely ligamentous injuries. Untreated Lisfranc injuries lead to progressive midfoot collapse and severe post-traumatic arthritis.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.