Foot & Ankle
Lisfranc Injury
Non-Operative & Operative management
About Your Injury
A Lisfranc injury involves the joints and ligaments at the midfoot, where the metatarsals meet the smaller bones of the arch. Many are unstable and require surgery, but injuries confirmed stable on weight-bearing assessment can be treated without surgery.
Non-Operative Management
Selected Lisfranc injuries can be safely and effectively managed without surgery when confirmed to be stable. The decision is individualised to each patient, based on patient factors (age, comorbidities, occupation) and injury characteristics (displacement, stability under load, joint alignment).
If there is no gross instability on the initial X-rays, you will often be allowed to weight-bear in a boot from the outset. Weight-bearing X-rays at 2 weeks are the key test that confirms the final treatment plan — if the joint remains stable under load, non-operative management continues; if not, surgery may still be required. If any concern remains, an MRI may be needed to visualise the ligamentous complex.
Recovery Timeline
Weeks 0–2
Weight-bearing as tolerated in a boot, then weight-bearing X-rays at 2 weeks to confirm stability and finalise the treatment plan.
Weeks 2–6
Continued weight-bearing as tolerated in the boot, with an arch support orthotic.
Weeks 6–12
Transition to a supportive running-style shoe, continuing the arch support orthotic for up to 6 months while the midfoot settles.
3–4 months
Return to sport once strength and confidence have recovered.
Follow-Up Schedule
2 weeks
Weight-bearing X-ray — the key appointment confirming the final treatment plan.
6 weeks
Clinical review of progress and transition planning.
3 months
Review of activity and return-to-sport progression.
Midfoot Arthritis
Midfoot arthritis is a recognised long-term risk after a Lisfranc injury, whether treated operatively or non-operatively. This risk is largely set at the time of injury, not by the treatment chosen — the treatment protocol aims to minimise it as much as possible.
Operative Management
When the midfoot joints are unstable, surgery is needed to restore alignment and hold the joints in the correct position while the ligaments heal.
Screws and plates are used to hold the affected midfoot joints in the correct position while the ligaments heal. A specific screw (the 'Lisfranc screw') secures the joint between the 1st and 2nd rays, and bridge plates — which span a joint without compressing it, so they can be removed later — are used across any other affected joints. Injuries involving the 1st and 2nd tarsometatarsal joints are usually treated through a single incision; more extensive injuries involving the 3rd and 4th joints as well require a second incision and additional plating. This procedure is performed under general anaesthetic, with local anaesthetic infiltration at the time of surgery for good pain control in the first 12–24 hours afterward, and usually requires an overnight stay in hospital.
Recovery Timeline
Weeks 0–2
Non-weight-bearing. Wound checked at follow-up before progressing.
Weeks 2–8
If the wound has healed well, weight-bearing as tolerated in a CAM boot.
8 weeks onward
Transition to supportive, rocker-bottom running shoes with an arch support.
6 months
Routine removal of hardware (all patients).
8 months total
8 weeks after hardware removal — cleared for high-impact running, jumping, and contact sport.
Follow-Up Schedule
2 weeks
Wound check — determines whether you can progress to weight-bearing in the boot.
6–8 weeks
Clinical review and transition to supportive footwear.
6 months
Hardware removal (day procedure).
8 months total
8 weeks post-hardware removal — final clearance for high-impact activity and contact sport.
Midfoot Arthritis
Midfoot arthritis is a recognised long-term risk after a Lisfranc injury. This risk is largely set at the time of injury, not by the surgery itself — the procedure aims to restore alignment and minimise this risk as much as possible.