Lisfrancs injury


  • Damage to one or all of the midfoot joints can result in pain, arthritis or instability.
  • Severe disruption can result in a flat foot deformity.
  • This can occur via a number of mechanisms including:
    • A high impact twisting injury such as often occurs in sporting activities where the toes are planted on the ground and the heel is loaded, or impact of the foot on the brake pedal such as occurs in a motor vehicle crash.
    • A low impact injury such as a slip or twist to the foot while descending a step or curb.

Diagnostic tips

  1. Pain in the midfoot area.
  2. Swelling of the foot.
  3. Unable to weightbear on the affected foot.
  4. Manipulation of the bones of the midfoot will create significant discomfort, specifically twisting the foot downwards and to the outside (pronation and abduction of the forefoot).
  5. Bruising in the central plantar area of the foot should raise suspicion for a significant injury.

Tests and Imaging

  1. Weightbearing X-rays help to identify extent of injury if no fracture is obvious. The gap between the bases of the 1st and 2nd metatarsals should be compared contralaterally.
  2. A CT scan or MRI may be necessary if the diagnosis or the extent of the injury is unclear.

Immediate Treatment

  1. Immobilization in cam walker and crutches (need at least a 6-week period where they are either non-weight bearing or minimally weight bearing) for stable Lisfrancs.
  2. Internal fixation may be indicated.

Possible Referral

  1. Podiatry for cam walker and appropriate rehabilitation.
  2. Orthopaedic foot surgeon for internal fixation.