Lisfranc Injuries

Home / Lisfranc Injuries

EXPERT PATIENT GUIDE · LONDON & NORTH LONDON

Lisfranc Injuries: A Complete Patient Guide

A comprehensive guide by Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore and UCL — caring for patients with foot, ankle and sports injuries across London and North London.

At a Glance: Lisfranc Injury

Condition	An injury to the group of joints and ligaments in the middle of the foot that lock the arch together. Doctors call this the Lisfranc, or tarsometatarsal, joint complex.
Also Known As	Midfoot sprain, tarsometatarsal (TMT) injury, Lisfranc fracture-dislocation.
How Common	About 1 in 55,000 people a year. Up to a third now happen during sport, as doctors are getting better at spotting them.
Frequently Missed	About 1 in 5 of these injuries are missed on the first X-rays — which is why it helps to see a specialist early.
Most Common Cause	A twist, or landing hard on a pointed foot, usually during sport. It can also be caused by something heavy crushing the foot.
Diagnosis	X-rays of both feet taken while you stand, a standing (weight-bearing) CT scan, and an MRI scan.
Non-Surgical Care	A cast or boot, plus limits on how much weight you put through the foot, if the injury is stable and the bones have not shifted.
Surgical Options	Putting the bones back in place and holding them with screws or plates, permanently joining (fusing) the joints, or rebuilding the torn ligament.
Return to Sport	Up to about 92% of people get back to the same level of sport they played before, within two years.
Specialist	Mr Matthew Welck — Consultant Orthopaedic Foot & Ankle Surgeon, RNOH Stanmore & UCL, London and North London.

What Is a Lisfranc Injury?

A Lisfranc injury is damage to the joints and ligaments in the middle of your foot — the row where the long bones that lead to your toes (the metatarsals) meet the smaller bones of the midfoot (the cuneiforms and cuboid). Doctors call this the tarsometatarsal, or TMT, joint. It is the foundation of the arch of your foot, and it keeps the middle of the foot stiff and stable every time you push off.

The joint is named after Jacques Lisfranc de St. Martin, a French surgeon in Napoleon’s army who was the first to describe injuries in this part of the foot. The most important support is the Lisfranc ligament — a strong band that runs from one of the small midfoot bones (the medial cuneiform) to the base of the second long toe bone. There is no ligament joining the first and second long toe bones directly, so the base of the second one acts as the “keystone” that locks the arch — much like the central stone in an archway. If these ligaments tear or the bones shift out of line, the middle of the foot loses its stability.

These injuries range from a mild sprain, where almost nothing has moved out of place, through to a bad break where the bones come apart. Because the milder injuries can look almost normal at first, they are easy to underestimate — but if they are not treated they can lead to long-term pain, a change in the shape of the foot, and arthritis in the midfoot. Seeing a specialist early gives you the widest choice of treatments.

How Common Is It in the UK?

Lisfranc injuries are fairly rare. They have long been estimated to affect around 1 in 55,000 people each year, and they make up roughly 0.2% of all broken bones. The numbers reported have risen in recent years — not because more people are being injured, but because doctors are more aware of the injury and modern scans mean fewer are missed.

Importantly, around one in five Lisfranc injuries are still missed on the first set of X-rays, and some studies suggest that up to a third are given the wrong diagnosis to begin with. Sport is an increasingly recognised cause: up to a third of Lisfranc injuries now happen during sport, and they are a well-known problem in footballers, rugby players, dancers and other athletes. This is exactly the sort of quiet, easily overlooked sports injury where seeing a foot and ankle surgeon early makes a real difference.

What Causes a Lisfranc Injury?

Lisfranc injuries are usually grouped by how they happen:

Indirect (lower force): a twist or bend through a foot that is pointed downwards — the classic sporting injury. This might be landing awkwardly, falling onto a pointed foot, or another player landing on your heel while your foot is planted.
Direct (high force): something heavy crushing the top of the foot, as can happen in road accidents, falls from a height and accidents at work. These injuries usually come with a lot of swelling and damage to the skin and soft tissues.

Injuries are also described by what is damaged:

Ligament injuries: the ligaments tear but the bones themselves are not broken. Injuries that involve the ligaments alone can be slower to heal.
Bone or mixed injuries: as well as ligament damage, there are breaks in the bases of the long toe bones or the bones around them.

What Are the Symptoms?

Pain across the middle of the foot, which is worse when you stand, walk or push off
Swelling over the top of the middle of the foot
Finding it hard, or impossible, to put weight on the foot
Bruising on the sole of the foot — one of the most reliable signs of a serious injury to the middle of the foot
A feeling that the foot is unstable, “gives way” or flattens out
Pain that comes on when the front of the foot is twisted or the middle of the foot is squeezed

When to seek specialist advice: If your pain and swelling seem far worse than a “normal” X-ray would suggest, a Lisfranc injury should always be considered. If you have these symptoms after twisting or crushing your foot, it is worth being seen by a specialist.

What Investigations Might You Need?

X-rays taken standing up: the first test. Both feet are X-rayed and compared side by side, looking for a gap opening up between the first and second long toe bones, and for a small flake of bone (the “fleck sign”) that shows a ligament has pulled away.
Standing (weight-bearing) CT scan: a modern, low-dose 3D scan taken while you are standing. Because it shows the foot while it is taking your weight, it is especially good at picking up slight instability that ordinary scans miss — and Mr Welck uses it routinely at the RNOH.
MRI scan: shows the ligaments themselves, and can confirm a mild sprain when the X-rays look normal.
Stress test: occasionally the middle of the foot is gently pushed and pulled while live X-ray pictures are taken, to check whether the joint really is unstable.

All of these tests aim to answer one question: is the injury stable or unstable? A stable injury, where nothing has moved out of place, may be treated without surgery. An unstable one usually needs an operation to put the middle of the foot back into line.

Non-Surgical Treatment

Not every Lisfranc injury needs surgery. If the injury is a true sprain, nothing has moved out of place and the middle of the foot is stable, it can heal well with rest and protection:

A period in a cast or walking boot to keep the foot still
Keeping weight off the foot, or putting only limited weight through it, usually for around six weeks
A gradual return to normal shoes and activity once the foot is comfortable and stable
Physiotherapy to rebuild strength, balance and confidence

It is important to keep an eye on stable injuries with repeat standing X-rays, because a small number shift out of place during the early weeks of healing. If that happens, or if the injury was unstable from the start, surgery is advised to avoid long-term problems.

Surgical Options

When a Lisfranc injury is unstable, the aim of surgery is to put the middle of the foot back into its normal position and hold it there while the bones and ligaments heal. The right operation is different for everyone. It depends on your age, how active you are, and whether the injury involves the ligaments alone or broken bones as well.

Open Reduction and Internal Fixation (ORIF)

The bones are put back into position and held with screws, plates or both. One method, called bridge plating, avoids drilling across the joint surface. This is the traditional operation and works well, especially where bones are broken. The screws or plates protecting the joint are often taken out a few months later, once healing is well under way.

Suture-Button / Flexible Fixation

For certain milder injuries that involve the ligaments only, a strong flexible device can be used to hold the first and second parts of the foot together. It works like the Lisfranc ligament, while still allowing a little natural movement. This can avoid a second operation to remove metalwork.

Primary Fusion (Arthrodesis)

The injured joints are permanently joined together. For injuries involving the ligaments alone, good-quality research has shown that fusing the joints straight away can give a quicker recovery, better function and a more reliable return to activity than holding them with screws and plates — because torn ligaments heal less predictably than bone. Fusion is also the preferred operation when there is already arthritis in the joints.

Whichever operation you have, recovery usually involves a period in a cast or boot, limits on the weight you put through the foot, and physiotherapy. Most people can expect to return to sport from around six months, and studies report that up to 92% get back to the level of sport they played before the injury within two years.

Chronic Lisfranc Injuries

This section is about chronic Lisfranc injuries — ones that are diagnosed or treated late. These are a separate and more difficult problem, and the treatment is not the same as for a fresh injury.

What Is a Chronic Lisfranc Injury?

A Lisfranc injury is usually called chronic when it is first picked up more than about six weeks after the original injury. Because many Lisfranc injuries are missed at first, people often come forward months, or sometimes years, later. They fall into two broad groups: people who have already developed arthritis in the midfoot joints, and people whose foot is unstable but who do not have arthritis yet — often younger, active people whose injury was missed or diagnosed late.

How Is It Diagnosed?

The diagnosis is based on your story (ongoing pain and a feeling of instability in the middle of the foot during everyday activity), together with an examination and scans. Standing X-rays of both feet are compared side by side to look for a gap opening up between the small midfoot bone (the medial cuneiform) and the base of the second long toe bone. A standing CT scan and an MRI add more detail, and a stress test may be used to confirm the instability. An important part of the assessment is working out whether arthritis has already set into the midfoot joints, because this guides the choice of treatment.

How Is the Treatment Different? In a fresh injury, simply putting the bones back into line and fixing them is often enough. In a long-standing injury this is less reliable: the torn ligaments have lost their natural ability to heal, so fixing the bones alone may not give lasting stability. Treatment therefore has to be tailored:

Fusion (arthrodesis): permanently joining the joints together. This is the most predictable option, and the usual choice when the joints are already worn. It reliably relieves pain, but you lose a small amount of the natural movement in the middle of the foot — a trade-off that matters more for younger, very active people.
Ligament reconstruction: for carefully chosen younger people who have instability but no arthritis, the damaged Lisfranc ligament can be rebuilt using a piece of tendon (for example, a strip of one of your own tendons). This is a more specialist option that aims to restore stability while keeping the joint moving.
Careful treatment without surgery: this suits the small number of long-standing injuries that are still stable, have not moved out of place and show no arthritis.

Research in this area is still developing, but the outlook is encouraging. People who have surgery for long-standing Lisfranc instability without arthritis usually show a marked improvement in recognised foot and ankle scores — for example, average scores rising from the mid-50s before surgery to the high-80s afterwards — with few complications. The key message is that even a Lisfranc injury found late can be treated — and the right operation depends on your own anatomy, symptoms and goals, which is best decided together with a specialist.

Why Choose Mr Welck?

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore — one of the UK’s leading specialist orthopaedic hospitals — and Honorary Associate Clinical Professor at UCL. He treats problems of the foot and ankle only.

His special interests include complex foot and ankle reconstruction, redo (revision) surgery, total ankle replacement, standing CT scanning and the treatment of sports injuries such as Lisfranc injuries. He has written over 50 published research papers, completed two specialist fellowships including training abroad, and has led the way in standing CT scanning and in using 3D-printed, custom-made surgical guides for complex deformity.

Patients are seen across London and North London, with quick access to MRI, standing CT and a full team of specialists. Every option is talked through openly, and you and Mr Welck agree a plan together that is built around you. Mr Welck treats both NHS patients at the RNOH and private patients across the capital.

Frequently Asked Questions

What is a Lisfranc injury?

A Lisfranc injury is damage to the ligaments and joints in the middle of the foot (the tarsometatarsal or Lisfranc joint). It ranges from a mild sprain to a break where the bones come out of place and, if it is missed, it can lead to long-term pain and arthritis in the middle of the foot.

How serious is a Lisfranc injury?

It can be more serious than it first appears. Because milder injuries can look almost normal on early X-rays, and around one in five are missed, an untreated Lisfranc injury can cause lasting instability, a change in the shape of the foot, and arthritis. Early specialist assessment is important.

Can a Lisfranc injury heal without surgery?

Yes, if it is stable and the bones have not moved. These injuries can heal in a cast or boot, with a period of limited weight through the foot and repeat X-rays to check progress. Unstable injuries usually need surgery to put the foot back into line.

How long is recovery after Lisfranc surgery?

Most people spend several weeks in a cast or boot, putting limited weight through the foot, followed by physiotherapy. Comfortable walking usually comes back over a few months, and fuller recovery takes longer. Everyone’s timeline is different.

When can I return to sport after a Lisfranc injury?

Return to sport is generally expected from around six months, depending on the injury and the operation. Studies report that up to 92% of patients return to their pre-injury level of sport by two years.

What happens if a Lisfranc injury is missed?

A missed or late-treated (chronic) Lisfranc injury can lead to ongoing instability and arthritis in the middle of the foot. It can still be treated, but the surgery is more specialised — options include fusing the joints or, in some younger people, rebuilding the ligament.

Where can I see a foot and ankle surgeon for a Lisfranc injury in London or North London?

Mr Matthew Welck consults across London and North London. NHS patients are seen at the Royal National Orthopaedic Hospital (RNOH) Stanmore. Private appointments can be booked on 07547 395 270 or by emailing secretary@matthewwelck.com.

Book a Consultation

If you have midfoot pain, swelling or instability after a foot injury — or you are worried a Lisfranc injury may have been missed — specialist assessment can make a significant difference to your outcome.

Book a private or NHS consultation with Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon. Being seen early gives you the widest choice of treatments and the best long-term result.

Call: 07547 395 270
Email: secretary@matthewwelck.com
Private appointments: London and North London locations
NHS referrals: via your GP to RNOH Stanmore

This page is for general patient information and does not replace an individual consultation. Please seek specialist advice for your own condition.

Book an Appointment View All Treatments

Written by: Matthew Welck | Consultant Orthopaedic Foot & Ankle Surgeon London — last updated 2 August 2026