Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer: A Lisfranc injury involves disruption of the ligaments and/or bones of the tarsometatarsal (Lisfranc) joint complex in the midfoot. It’s frequently missed on standard X-rays if weight-bearing views aren’t obtained. Even seemingly minor Lisfranc sprains require careful management — untreated instability leads to midfoot arthritis and chronic pain. Unstable injuries require surgical fixation.
The Lisfranc Joint Complex
The Lisfranc joint complex is the articulation between the metatarsal bases and the tarsal bones in the midfoot. The Lisfranc ligament — running from the medial cuneiform to the second metatarsal base — is the primary stabilizing structure of this complex. Disruption of this ligament and its associated structures, from sprain to fracture-dislocation, constitutes a Lisfranc injury. The injury is named for French surgeon Jacques Lisfranc de St. Martin, who described it in Napoleon’s cavalry when soldiers’ feet were caught in stirrups during falls.
Why Lisfranc Injuries Are Frequently Missed
Lisfranc injuries are missed in approximately 20-40% of cases on initial presentation — a tragic rate given the consequences of missed diagnosis. Reasons: non-weight-bearing X-rays may appear normal; the injury may look like a ‘bad foot sprain’; patients often continue walking despite significant instability; and emergency department providers may not obtain the weight-bearing views needed to demonstrate displacement. The diagnostic key: weight-bearing X-ray — which reveals the characteristic widening between the first and second metatarsal bases that non-weight-bearing films conceal.
Recognition and Diagnosis
Suspicious signs warranting Lisfranc workup: midfoot pain and swelling after trauma (motor vehicle accident, fall from height, twisting mechanism), plantar bruising at the arch (highly specific sign — if you see midfoot bruising, get weight-bearing X-rays), point tenderness over the Lisfranc joint (between first and second metatarsal bases), inability to bear weight without severe pain. Diagnosis requires weight-bearing AP and oblique X-rays. CT scan provides detailed bony assessment. MRI evaluates ligamentous integrity for purely ligamentous injuries.
Treatment Options
Stable Lisfranc sprains (no displacement on weight-bearing X-ray): non-weight-bearing in a cast or boot for 6 weeks, followed by gradual weight bearing and physical therapy. Unstable injuries (>2mm displacement or any diastasis): surgical fixation required — options include temporary screw/plate fixation (removed at 3-4 months as midfoot requires motion), or primary arthrodesis (fusion) for severe fracture-dislocation patterns. Outcomes are dramatically better when instability is recognized and treated early versus after months of weight-bearing on an unstable joint.
Dr. Tom's Product Recommendations
Aircast AirSelect Walker Boot
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Pneumatic walking boot used for stable Lisfranc sprains and post-surgical rehabilitation. Provides midfoot immobilization during the healing phase.
Dr. Tom says: “https://m.media-amazon.com/images/I/61GHMHkRbPL._AC_SL300_.jpg”
Stable Lisfranc sprain immobilization, midfoot injury rehabilitation
Unstable Lisfranc injuries requiring non-weight bearing and surgical evaluation
Disclosure: We earn a commission at no extra cost to you.
PowerStep Pinnacle Orthotic
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Rigid arch support orthotic for chronic post-Lisfranc midfoot pain management and medial arch support during late rehabilitation.
Dr. Tom says: “https://m.media-amazon.com/images/I/71k+PB6ZHLL._AC_SL300_.jpg”
Late rehabilitation phase, chronic midfoot pain management after Lisfranc healing
Acute Lisfranc injury — requires proper diagnosis and management before orthotic use
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Early diagnosis and proper treatment prevents chronic midfoot arthritis and disability
- Stable Lisfranc sprains heal well with appropriate non-weight-bearing immobilization
- Modern surgical fixation techniques provide reliable stability for unstable injuries
❌ Cons / Risks
- Missed Lisfranc injuries with delayed treatment have substantially worse outcomes
- Full recovery takes 6-12 months even with optimal treatment
- Post-traumatic midfoot arthritis can develop even with appropriate treatment in severe injuries
Dr. Tom Biernacki’s Recommendation
I have a strong reaction when I see a patient who had a ‘midfoot sprain’ diagnosed at an emergency room months ago and is still not better — because a significant percentage of those are missed Lisfranc injuries. The ED got non-weight-bearing X-rays that looked normal, told them it was a sprain, and sent them home. Weight-bearing X-rays would have shown the diastasis. That window for surgical fixation closed weeks ago. Now we’re managing chronic midfoot instability. This is why I push hard for weight-bearing imaging whenever a midfoot mechanism or plantar bruising is present.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Can I walk on a Lisfranc injury?
Stable Lisfranc sprains may allow weight bearing with significant pain. Unstable injuries with displacement should be treated as non-weight-bearing — walking on an unstable Lisfranc joint significantly worsens the injury and the prognosis. If you’ve had a midfoot injury and have severe midfoot pain with weight bearing, seek evaluation immediately.
What does plantar bruising mean for a foot injury?
Bruising on the bottom of the foot (plantar surface) after foot trauma is highly specific for Lisfranc injury — it represents blood tracking from the disrupted Lisfranc ligament and associated structures. If you see plantar bruising after a midfoot injury, seek urgent foot and ankle specialist evaluation with weight-bearing X-rays.
How long does Lisfranc recovery take?
Return to sport typically takes 9-12 months after surgical fixation, with hardware removal at 3-4 months being a significant milestone. Conservative management of stable sprains takes 3-6 months. Full symptom resolution in severe cases may take up to 2 years.
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📞 (810) 206-1402 Book Online →When Shoes Aren’t Enough — Dr. Tom’s Top 9 Orthotics
About 30% of patients I see for foot pain need MORE than a great shoe — they need a structured insole. Below: my complete 2026 orthotic ranking with pros, cons, and the specific patient I’d give each one to.
★ DR. TOM’S COMPLETE 2026 ORTHOTIC RANKING
9 Best Prefab Orthotics by Use Case
PowerStep, Currex, Spenco, Vionic, and PowerStep Pinnacle — every orthotic I’ve fitted to thousands of patients across both Michigan offices. Each card includes pros, cons, and the specific patient I’d give it to. Real Amazon ratings, review counts, and prices below.
Best All-Purpose Orthotic for Most Patients
Semi-rigid arch shell + dual-layer cushion + deep heel cup. The orthotic I’ve fitted to more patients than any other for 15 years. APMA-accepted. Trim-to-fit design works in athletic shoes, casual shoes, and most work boots.
✓ Pros
- Semi-rigid arch shell provides true biomechanical correction
- Deep heel cup centers the heel and reduces lateral instability
- Dual-layer cushion (top + bottom) lasts 9-12 months daily wear
- Available in 8 sizes for precise fit
- APMA-accepted and clinically validated
- Lower price than PowerStep Pinnacle for equivalent function
✗ Cons
- Too thick for most dress shoes (use ProTech Slim instead)
- Some break-in period required (3-7 days for arch tolerance)
- Not enough correction for severe pes planus or rigid pes cavus
Dr. Tom’s Recommendation: If a patient has run-of-the-mill plantar fasciitis, mild flat feet, or arch fatigue, this is the first orthotic I try. Better value than PowerStep Pinnacle for 90% of patients, which is why I swapped it into our clinic kits three years ago. Sub-$50 typically.
Maximum Motion Control · Flat Feet & Severe Over-Pronation
PowerStep’s most aggressive stability orthotic. Adds a 2°-7° medial heel post on top of the standard PowerStep platform — designed specifically for flat-footed patients and severe pronators who need real corrective force.
✓ Pros
- 2°-7° medial heel post adds aggressive pronation control
- Same trusted PowerStep arch shell, more correction
- Built specifically for flat-foot biomechanics
- Excellent for posterior tibial tendon dysfunction (PTTD)
- Removable top cover for cleaning
✗ Cons
- Too aggressive for neutral-arch patients
- Needs longer break-in (10-14 days) due to stronger correction
- Adds 2-3 mm of stack height — won’t fit slim dress shoes
Dr. Tom’s Recommendation: When a patient comes in with significant flat feet AND symptoms (heel pain, arch pain, knee pain), the Original PowerStep isn’t aggressive enough. The Maxx is what gets prescribed. About 25% of my flat-footed patients end up here.
Low-Profile · Fits Dress Shoes & Narrow Casuals
3 mm slim profile with podiatrist-designed tri-planar arch technology. Engineered specifically to fit inside dress shoes, oxfords, loafers, and women’s flats without crowding the toe box. Vionic was founded by an Australian podiatrist.
✓ Pros
- 3 mm slim profile (vs 7-10 mm for standard orthotics)
- Tri-planar arch technology adds support without bulk
- Built-in deep heel cup despite slim design
- Fits dress shoes WITHOUT having to remove the factory insole
- Trim-to-fit · APMA-accepted
✗ Cons
- Less arch support than full-volume orthotics
- Top cover wears faster than thicker alternatives
- Not enough correction for severe foot deformities
Dr. Tom’s Recommendation: My default when a patient says ‘I need orthotics but I have to wear dress shoes for work.’ Slim enough to fit in oxfords and pumps without the heel sliding out. The single highest-impact change you can make for office workers with foot pain.
Built-In Metatarsal Pad · Morton’s Neuroma · Ball-of-Foot Pain
Standard Pinnacle orthotic with a built-in metatarsal pad positioned proximal to the metatarsal heads — the exact location that offloads neuromas and metatarsalgia. No need for separate met pads or pad placement guesswork.
✓ Pros
- Built-in met pad eliminates DIY pad placement errors
- Specifically designed for Morton’s neuroma + metatarsalgia
- Same trusted PowerStep arch + heel cup platform
- Top cover protects sensitive forefoot skin
- Faster relief than orthotics + add-on met pads
✗ Cons
- Met pad position is fixed (can’t fine-tune individual placement)
- Some patients with very small or very large feet need custom
- Slightly thicker than the standard Pinnacle
Dr. Tom’s Recommendation: If a patient has Morton’s neuroma, sesamoiditis, or generalized ball-of-foot pain (metatarsalgia), this saves a clinic visit and a prescription. The built-in pad placement is anatomically correct for 80% of feet. Way better than DIY met pads.
Adaptive Dynamic Arch · Athletic & Daily Wear
Currex’s flagship adaptive arch technology — the orthotic flexes with your gait instead of fighting it. Different stiffness zones along the length give you targeted support at the heel, midfoot, and forefoot. Available in three arch heights (low/medium/high).
✓ Pros
- Dynamic flex zones adapt to natural gait cycle
- Three arch heights ensure precise fit
- Lighter than rigid orthotics (no ‘heavy foot’ feel)
- Excellent for runners and athletic walkers
- European podiatric design (German engineering)
✗ Cons
- More expensive than PowerStep Original ($55-65 typically)
- Less aggressive correction than Pinnacle Maxx for severe cases
- Three arch heights means you must self-select correctly
Dr. Tom’s Recommendation: I started recommending Currex three years ago for runners who said PowerStep felt ‘too rigid.’ The dynamic flex zones respect natural gait. Best for active patients who walk 8K+ steps daily and don’t need maximum motion control.
Running-Specific · Heel Strike + Forefoot Strike Compatible
Currex’s purpose-built running orthotic. The midfoot flex zone is positioned for runner’s gait mechanics, with a flared heel cushion for heel strikers and a forefoot rocker for midfoot/forefoot strikers. Tested on 1000+ runners during product development.
✓ Pros
- Designed by German biomechanics lab specifically for runners
- Dynamic arch flexes with running gait (not static like PowerStep)
- Three arch heights (low/medium/high)
- Reduces overuse injury risk in mid-distance runners
- Lightweight (no impact on cadence)
✗ Cons
- Premium price ($60-75)
- Not aggressive enough for severe over-pronators (use Pinnacle Maxx)
- Runner-specific design = less ideal for daily walking shoes
Dr. Tom’s Recommendation: If a patient runs 20+ miles per week and has plantar fasciitis or shin splints, this is the orthotic I prescribe. The dynamic flex zones respect running biomechanics in a way that no rigid PowerStep can match. Pricier but worth it for serious runners.
Cavus Foot & High-Arch Patients
Polyurethane base with a deeper heel cup and higher arch profile than PowerStep — built for cavus (high-arched) feet that need maximum cushion and support. The 5-zone cushioning system addresses the unique pressure points of high-arch feet.
✓ Pros
- Deeper heel cup centers the heel for cavus foot stability
- Higher arch profile fills the void under high arches
- 5-zone cushioning addresses cavus foot pressure points
- Polyurethane base lasts 12+ months
- Available in Wide width
✗ Cons
- Too tall/aggressive for normal or low arches
- Won’t fit slim dress shoes
- Pricier than PowerStep Original
- Some patients find the arch height uncomfortable initially
Dr. Tom’s Recommendation: Cavus foot patients are often misdiagnosed and given low-arch orthotics — that makes everything worse. Spenco’s Total Support has the arch profile that high-arch feet actually need. About 15% of my patients have cavus feet; this is what they wear.
Cushion Layer · Standing All Day · Gel Pressure Relief
NOT a true biomechanical orthotic — this is a cushion insole. But for patients who want gel pressure relief instead of arch correction (or to add ON TOP of factory insoles in work boots), this is the best gel option on Amazon.
✓ Pros
- Genuine gel cushioning (not foam pretending to be gel)
- Targeted gel waves under heel and ball of foot
- Trim-to-fit · works in most shoe types
- Sub-$15 price (most affordable option in this list)
- Massaging texture is genuinely soothing
✗ Cons
- ZERO arch support — this is cushion only
- Won’t fix plantar fasciitis or flat-foot issues
- Compresses faster than PowerStep (4-6 months)
- Top cover wears through in high-mileage applications
Dr. Tom’s Recommendation: I recommend these to patients who tell me ‘I just want my feet to stop hurting at the end of my shift’ and who don’t have a biomechanical issue. Construction workers, factory workers, retail. Pure cushion does the job for them.
Tight-Fitting Shoes · Cycling Shoes · Hockey Skates
PowerStep Pinnacle’s slim version of their famous Green insole. The trademark stabilizer cap is preserved but the overall thickness is reduced — works in cycling shoes, hockey skates, ski boots, and other tight-fitting footwear that the standard PowerStep Pinnacle can’t fit into.
✓ Pros
- Stabilizer cap centers the heel (PowerStep Pinnacle’s signature feature)
- Slim profile fits tight athletic footwear
- Lasts 12+ months daily wear
- Excellent for cycling shoes specifically
- Built-in odor-control treatment
✗ Cons
- Premium price ($45-55)
- Less cushion than PowerStep equivalents
- Not as aggressive correction as Pinnacle Maxx for flat feet
- The signature ‘heel cup feel’ takes 1-2 weeks to adapt to
Dr. Tom’s Recommendation: If you’re a cyclist with foot numbness, hot spots, or knee pain — this is the orthotic. The stabilizer cap solves cycling-specific biomechanical issues that no other orthotic addresses. Worth the premium for athletes.
None of these solving your foot pain?
Some patients (about 30%) need custom-molded prescription orthotics. We make 3D-scanned custom orthotics in our Howell and Bloomfield Hills offices — specifically built for your foot mechanics.
Schedule a Custom Orthotic Fitting →FSA/HSA eligible · Most insurance accepted · (810) 206-1402
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)