• Two ways to fix it: screws or plates hold the bones rigidly; a TightRope (suture button) holds them with a strong cord, more like a ligament.
• Strong enough? For injuries that affect only the ligament, current studies show a TightRope gives results similar to screws at one year.
• Main advantage: a TightRope usually does not need removing, whereas screws often need a second operation.
• Not for every injury: broken bones, several damaged joints or major displacement usually need screws, plates or a fusion.
• What matters most: getting the bones back into exactly the right position, whichever method is used.

The Lisfranc joint sits in the middle of your foot, where the long bones of the forefoot meet the smaller bones of the arch. A tough band called the Lisfranc ligament holds the second long bone tightly to the bone beside it. It acts as a keystone for the arch of your foot.

A Lisfranc injury happens when this ligament is torn or the bones around it are broken or pushed out of place. It is common in sport, especially when the foot is twisted or landed on while pointed downwards. These injuries are easy to miss on a standard X-ray, which is why weight-bearing scans are so useful.

Read more about how these injuries are found in our article on what weight-bearing CT shows that an X-ray can’t. For a broader overview of the injury itself, see our guide to Lisfranc injuries.

If the bones have moved apart, even by a couple of millimetres, the arch can become unstable. Left untreated, this can lead to ongoing pain, a collapsing arch and arthritis in the midfoot. Surgery puts the bones back in the right place and holds them there while the ligament heals.

Stable injuries, where nothing has moved, can often be treated in a boot without an operation.⁷

Screws and Plates

This is the traditional method. A metal screw is passed across the joint, or a small plate is fixed over the top of it. Both hold the bones very firmly. The downsides are that a screw passes through the joint surface, screws can occasionally break, and they are often removed at three to six months, which means a second operation.

The TightRope (Suture Button)

A TightRope is made of a very strong braided cord with a small metal button at each end. It is passed through a narrow tunnel in the two bones and tightened. Instead of locking the bones rigidly, it holds them together a little like the original ligament. It does not cross the joint surface and is designed to stay in permanently.

This is the key question, and the honest answer is: for the right injury, yes.

In the Laboratory

Tests on donated feet show that a TightRope holds the bones close to their normal position, although a screw is much stiffer.⁶ That extra flexibility is deliberate, but it means the foot needs protecting while it heals.

In Patients

The most direct comparison so far followed 63 people with ligament-only Lisfranc injuries.¹ Six months after surgery, those treated with a TightRope reported less pain and better function, partly because the screw group still had their screws in. By one year the two groups were the same, both in how they felt and on X-ray. A few screws broke; neither group had a clear advantage in keeping the bones aligned.

Larger reviews pooling smaller studies report that most people treated with a TightRope return to sport, typically between three and six months, with few complications and almost no need for further surgery.²³ However, most of these studies are small, look back at past patients and follow them for only a year or two.

Some research has raised caution. One long-term study found that a few patients lost their correction or developed arthritis over five years.⁴ Another large hospital study found that people treated with a TightRope were more likely to need a later fusion operation.⁵ This most likely reflects TightRopes being used for injuries that were too severe for them.

• Around two weeks in a splint or cast to let the wound heal.
• Usually around six weeks in a boot without putting full weight through the foot.
• A gradual return to walking, often with an arch support, from about six weeks.
• Physiotherapy to rebuild strength and balance.
• Return to running and sport typically from three to six months, depending on the injury.

For advice on staying comfortable in the first few days, see our guide to pain relief after foot and ankle surgery.

A TightRope is a good, well-supported option for many ligament-only Lisfranc injuries, and it usually avoids a second operation to remove metalwork. It is not a replacement for screws in every case. The most important factor in your recovery is getting the bones back into exactly the right position, and choosing the method that suits your particular injury. That decision is best made together with your surgeon, using a careful examination and the right scans.

If you have pain in the middle of your foot after a twist or fall, or have been told you have a Lisfranc injury and want to understand your options, you can book a consultation.

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