Lisfranc Fracture

What is a Lisfranc fracture?

A Lisfranc fracture is a type of broken foot. The Lisfranc joint is the spot on top of your foot where the metatarsal bones (the bridges to your toes) connect to the rest of your foot.

This is a complicated area of your foot. It’s where many bones, ligaments and tendons all come together to hold your foot’s arch in shape and help it move properly. Because so many parts of your foot meet up in one place, the Lisfranc joint is very important. It’s just like a busy highway on-ramp or main intersection in a city: A lot depends on a relatively small area to make everything work correctly.

You can hurt any part of your Lisfranc joint. Lisfranc injuries are most commonly caused by an accident or some kind of trauma. Athletes can injure their Lisfranc joint playing sports, but even a small stumble or tripping throughout your day can cause an injury. Major traumas like car accidents and falling off a ladder also cause Lisfranc fractures and injuries. If you have a fracture, you broke at least one bone, but you can also tear or sprain any of the joint’s connective tissues.

How serious is a Lisfranc injury?

A Lisfranc injury isn’t life threatening, but is still very serious. Because the Lisfranc joint is so important to your ability to walk, run or move, breaking any of the bones in it — or injuring any of the ligaments and tendons supporting it — can have a big impact on your quality of life.

You need to get your injury examined by a healthcare provider as soon as possible. This will ensure you know exactly what’s wrong and which treatments will help you heal.

Like any bone fracture, the severity of the original injury and any damage done to your bones makes each Lisfranc injury unique.

How common are Lisfranc injuries?

Lisfranc injuries are relatively uncommon, but that might be because many people never get them officially or correctly diagnosed. In fact, experts estimate that up to 20% of Lisfranc injuries are missed or misdiagnosed when people visit emergency rooms with foot pain. That’s why it’s important to give your provider all the information you can about your injury. The more they know about what you’re feeling and how you got hurt, the sooner they can arrive at the right solutions for you.

Lisfranc fractures are only 0.2% of all reported broken bones. Only 1 out of every 55,000 people in the U.S. is diagnosed with one per year.

Who does it affect?

Lisfranc injuries and fractures can happen to anyone because they’re caused suddenly and by trauma. There’s no clear road map of who is more likely to experience a Lisfranc injury, but certain activities and health issues might slightly increase your risk:

• Playing competitive sports: Sports like football, soccer and basketball make your feet more vulnerable to being twisted, stepped on and crushed than other activities.
• Running: Lisfranc injuries are sometimes caused by repetitive overuse that puts stress on your feet.
• Diabetes or nerve damage: Any condition that reduces feeling in your feet makes it less likely that you recognize pain and other early symptoms of a Lisfranc injury.

Men in their 30s and athletes tend to be the most common people to get Lisfranc fractures.

How does a Lisfranc injury affect my body?

If you’re diagnosed with a Lisfranc injury or fracture, you’ll be unable to put weight on your injured foot for several weeks. Exactly how long depends on what is hurt or broken. Expect to wear a boot or cast that will prevent you from putting weight on your injured foot for at least six weeks.

If it’s not treated properly, a Lisfranc injury can lead to serious complications, including:

• Arthritis.
• Chronic pain.
• Collapsed arches.

What are the symptoms of a Lisfranc injury?

Lisfranc injuries — whether or not you have a fracture — often have the following symptoms on or near the top of your foot:

• Pain.
• Swelling, especially near the inside edge (instep).
• Bruising (can also appear on the bottom of your foot).
• You can’t put much or any weight on your foot: Even if you can put some weight on your foot, if you feel any discomfort, you might still have a Lisfranc injury.

What does a Lisfranc injury look like?

Your injured foot might look different than usual. Look for bruising or any discoloration on the top of your foot and on your foot’s sole. If possible, compare it to your uninjured foot. If something looks different or out of the ordinary, get your foot examined, especially if you’re in pain or can’t walk or move like you usually can.

What causes a Lisfranc fracture or injury?

Lisfranc injuries are almost always caused by a fall, slip or trauma to the foot. You might read about “direct” (high energy) and “indirect” (low energy) causes of Lisfranc injuries. These are different ways to help your provider understand the specifics of your injury. Direct causes are traumas that crush the Lisfranc joint, like car accidents or something falling on your foot at a worksite. Indirect causes are much more common and come from slips, falls and sports injuries. Anything that makes your heel unexpectedly twist or spin while you’re stepping with weight on the ball of your foot can injure your Lisfranc joint or fracture the small bones in it.

What you were doing when you injured your foot is often the best way for your provider to correctly identify and diagnose a Lisfranc fracture or injury. Make sure you share as much as you can about what led to your foot’s injury or what you were doing before you noticed symptoms like pain or bruising.

How is a Lisfranc fracture diagnosed?

A Lisfranc fracture is diagnosed with a few steps:

• Describing the injury/what happened (sometimes called a history or narrative evaluation).
• A physical exam of your feet.
• Imaging tests like X-rays, an MRI or a CT scan.

What caused the Lisfranc injury?

Your provider needs to know what caused your injury to correctly identify and diagnose a Lisfranc fracture or injury. It’s extremely important they know as much as possible, so make sure you share as much as you can about what you were doing before you noticed pain, bruising or other symptoms. Because even little slips or stumbles can cause a Lisfranc injury, the more details you can share the better — including how your foot was positioned when it was injured.

Physical exam

Your provider will examine your foot and compare it to your other, uninjured foot (if possible). They will also examine the injured or painful area and check its shape and stability.

What tests will be done to diagnose a Lisfranc injury?

After a physical exam, you’ll likely need at least one of a few imaging tests to take pictures of your foot:

• X-rays: Confirm any Lisfranc or other fractures, and show how out of place your foot’s bones are.
• Magnetic Resonance Imaging (MRI): If ligaments, tendons or other, non-bony parts of your Lisfranc joint are injured, your provider might use an MRI to get a complete picture of your foot and any damage inside it.
• CT scan: If you need surgery your provider or surgeon needs to know exactly how damaged your bones are. A CT scan will give them a more detailed picture of your bones and the surrounding tissue than an X-ray.

How is a Lisfranc injury treated?

Your treatment will depend on your specific injury, and whether or not you have any broken bones. You might need surgery. Most people wear a cast or boot for six to 12 weeks, and it can take a year or more to return to intense exercise like running or playing sports.

Lisfranc injury non-surgical treatment (wearing a boot or cast)

If you don’t have a Lisfranc fracture — or if your broken bones are not too far out of place — and your ligaments aren’t too damaged, your provider will put your injured foot in a boot or cast. This will reduce stress on your hurt foot, hold it in place and keep you from putting weight on it. You’ll also likely need to elevate your foot as often as you can, especially right after your injury. You might also need to use crutches to make sure you can’t put weight on the injured foot.

Six to eight weeks later, your provider will check your progress, often with follow-up X-rays. If your Lisfranc injury has healed well enough and you’re no longer experiencing pain, you should be able to put some weight back on your foot as part of a physical therapy plan.

Lisfranc surgery

You will likely need surgery if the bones and ligaments in your foot are severely damaged or shifted from their usual position (displaced) by your injury. This is especially important after severe traumas or accidents. A surgeon will make sure your foot is repaired back to its original shape by putting plates and screws into your foot while your bones and connective tissues heal. Lisfranc surgery is outpatient surgery, meaning you will likely go home the same day. Expect to spend up to three months in a combination of a cast and boot after your surgery.

What are some potential complications of Lisfranc injury treatment?

Treating a Lisfranc injury or fracture can have several risks:

• Nerve damage: There’s a chance the nerves in your foot are temporarily or permanently damaged, especially if you have surgery.
• Arthritis: People who have had Lisfranc injuries or fractures commonly develop arthritis in the injured Lisfranc joint. Severe arthritis might require its own treatment later.
• Bone infection (osteomyelitis): If you have an open Lisfranc fracture (the bone breaks through your skin) you have an increased risk of bacterial infection.
• Other internal damage: Fractures can damage the area around the injury including your muscles, nerves, blood vessels, tendons and ligaments.

How to take care of myself/manage symptoms of a Lisfranc injury?

Mild symptoms can be treated at home:

• Icing the painful area.
• Elevating your foot as often as possible.
• Resting the foot to prevent further damage.

Your provider or surgeon will give you specific instructions for how to care for your injury during/after treatment or surgery. If your symptoms don’t get better after a few days of these at-home treatments, you should get your foot examined by a healthcare provider.

What medications can I take with a Lisfranc injury?

Talk to your provider before taking any medications to reduce pain after any treatment. Over-the-counter pain relievers (such as ibuprofen or acetaminophen) may reduce pain and swelling.

How long does it take to recover from Lisfranc injury treatment?

Remember: Everyone’s body heals at different speeds, so make sure to talk through your exact treatment timeline with your provider.

• Non-surgical treatments (boot or cast only): Likely six to eight weeks followed by some physical therapy.
• Lisfranc surgery: Up to three months in a combination of a boot or cast after your surgery followed by some physical therapy.

How can I prevent a Lisfranc injury?

Lisfranc injuries happen from accidents and without warning. Because falls and slips are common causes of Lisfranc injuries and fractures, make sure your home and workspace are free from clutter that could trip you or others. If you play sports, make sure you’re wearing appropriate footwear that gives you the best support and protection.

How long does a Lisfranc injury take to heal?

Healing time depends on the severity of your fracture and which treatments you needed. It can take anywhere from a few months to more than a year to recover fully.

When can I go back to work/school?

Your ability to work or go to school may be limited, depending on your job or where you go to school. Because you’ll be unable to walk long distances — or put any weight on your injured foot — you might need to miss work. Your provider or surgeon will tell you how long you should wait before returning to walking, exercising or playing sports. In many cases (especially if you have a Lisfranc fracture) it might take a year or more before you’re cleared to return to heavy exercise or sports.

When should I see my healthcare provider or go to the emergency room?

If you think you have a Lisfranc injury or fracture, get it examined by a healthcare provider right away. This includes having any of these symptoms:

• Intense pain.
• Swelling.
• Tenderness.
• Bruising.
• You can’t move your foot or put weight on it.

If your symptoms don’t get better after a few days of at-home treatments like icing the area and keeping it elevated, you should get your foot examined by a healthcare provider.

If you experienced a fall or other trauma, make sure you tell your healthcare provider or the emergency responders everything that happened.

Can a Lisfranc injury heal on its own?

Lisfranc injuries are extremely unlikely to heal on their own. Because they’re so tricky to diagnose, what might seem like a simple sprain or another common injury could be something much more serious. A neglected Lisfranc injury can become much worse if it’s not examined by a qualified healthcare provider as soon as possible.

What questions should I ask my healthcare provider?

• How do I know if I have a Lisfranc injury or fracture?
• Will I need to wear a boot or cast?
• Do I need surgery?
• Will I require physical therapy?
• How soon can I use my foot again?
• When can I play sports or work out?
• When will my foot be completely healed?

A note from Cleveland Clinic

You might have injured your Lisfranc joint missing a step on the basement stairs or as part of a larger, scarier trauma like a car accident. No matter what caused it, any unusual pain, swelling or bruising in your foot should be examined by a healthcare provider as soon as possible. Even if your injury ends up being something less serious, a Lisfranc injury — especially a fracture — can lead to lots of issues later on if you don’t get it treated correctly right away.