Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Lisfranc Injuries: From Subtle Sprains to Frank Dislocations relates to foot/ankle injury — typically caused by trauma or twist. Most patients improve in 4-8 weeks with conservative care. Same-week appointments in Howell + Bloomfield Twp: (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
▶ Watch
Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Lisfranc injuries — disruptions of the tarsometatarsal (TMT) joint complex — represent a spectrum from subtle ligamentous sprains that are the most commonly missed significant foot injury in emergency medicine, to complete fracture-dislocations of the midfoot that are immediately apparent. The injury carries critical clinical significance because missed or undertreated Lisfranc injuries produce chronic midfoot instability, posttraumatic arthritis, progressive flatfoot collapse, and permanent functional disability. A high index of suspicion is required because subtle Lisfranc sprains can appear deceptively benign on initial clinical and radiographic evaluation.
Anatomy
The Lisfranc joint complex consists of the articulations between the five metatarsal bases and the three cuneiforms plus the cuboid. The keystone of stability is the Lisfranc ligament — a strong oblique ligament running from the medial cuneiform to the base of the second metatarsal (there is no direct first-to-second intermetatarsal ligament, creating the anatomic vulnerability). The second metatarsal base is mortised into a recessed position between the medial and lateral cuneiforms, providing the osseous stability of the “Roman arch” structure of the midfoot. Disruption of the Lisfranc ligament — whether isolated sprain or combined with osseous fractures — compromises this arch and allows metatarsal instability.
Injury Patterns and Classification
Myerson’s classification divides Lisfranc injuries into: Type A (total incongruity — all five TMT joints displaced in the same direction), Type B (partial incongruity — medial or lateral column involved selectively), and Type C (divergent — medial column displaced medially, lateral column displaced laterally). The energy mechanism influences severity: low-energy twisting injuries (falling off a curb, foot trapped in a stirrup) produce ligamentous sprains or avulsion fractures; high-energy mechanisms (motor vehicle crush, fall from height) produce complex fracture-dislocations. The fleck sign — a small avulsion fracture fragment at the second metatarsal base or medial cuneiform where the Lisfranc ligament inserts — is pathognomonic for ligamentous disruption on plain X-ray.
Diagnosis: The Critical Challenge
Non-weight-bearing X-rays may appear normal in subtle Lisfranc sprains — the key diagnostic study is a weight-bearing AP foot X-ray, where TMT instability manifests as diastasis (gap) between the first and second metatarsal bases, loss of alignment between the medial border of the second metatarsal and the medial border of the middle cuneiform, or abduction of the metatarsals. A gap greater than 2 mm on weight-bearing X-ray between the first and second metatarsal bases indicates significant ligamentous disruption requiring surgical stabilization. MRI identifies pure ligamentous Lisfranc injury without fracture and is the gold standard for subtle injury characterization. CT defines fracture morphology for surgical planning.
Treatment
Stable Lisfranc sprains (less than 2 mm diastasis on weight-bearing stress X-ray, intact on MRI) are managed non-surgically with a non-weight-bearing cast for 6–8 weeks followed by progressive weight-bearing in a rigid boot to 12 weeks. Unstable injuries (greater than 2 mm diastasis, positive stress X-ray) require surgical stabilization — open reduction and internal fixation with screws across the medial and intermediate columns, and bridge plating or Kirschner wires across the lateral column. Primary arthrodesis of the medial column (first, second, and third TMT joints) produces superior outcomes to ORIF for ligamentous injuries without fracture in multiple comparative studies. Return to sport typically occurs at 6–9 months after surgical stabilization.
Lisfranc Injury Evaluation at Balance Foot & Ankle
Dr. Biernacki at Balance Foot & Ankle evaluates midfoot injuries with weight-bearing X-rays when clinically indicated, identifies the fleck sign, and coordinates MRI or CT evaluation for suspected Lisfranc injuries. Same-week evaluation is available for midfoot pain after a twisting injury. Call (810) 206-1402.
Midfoot Pain After Injury? Get Evaluated Promptly.
Serving Southeast Michigan from Bloomfield Hills and Howell.
📞 (810) 206-1402 |
📧 Get Dr. Tom’s Free Lab Test Guide
Discover the 5 lab tests every person over 35 should ask their doctor about — explained in plain English by a board-certified physician.
📍 Located in Michigan?
Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
Get Directions →
Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
Get Directions →
Your Board-Certified Podiatrists
Ready to Get Back on Your Feet?
Same-week appointments available at both locations.
Book Your AppointmentDifferential Diagnosis: What Else Could It Be?
Not every case of lisfranc (midfoot) injury is straightforward. In our clinic we routinely rule out three look-alike conditions before confirming the diagnosis. If your symptoms don’t match the classic presentation, one of these may explain the pain — which is why physical exam matters more than self-diagnosis.
| Condition | How It Differs |
|---|---|
| Midfoot sprain | No diastasis on X-ray; able to bear weight after initial pain. |
| Navicular stress fracture | Dorsal midfoot pain with impact loading; stress fx confirmed on MRI. |
| Cuboid syndrome | Lateral midfoot pain, often following ankle inversion; relieved by cuboid whip. |
Red Flags — When to See a Podiatrist Now
Seek same-day evaluation at Balance Foot & Ankle if you notice any of the following:
- Pain out of proportion to injury severity
- Plantar bruising across the arch (classic Lisfranc sign)
- Inability to bear weight for >24 hours
- Widening of tarsometatarsal joints on weight-bearing X-ray
Call (810) 206-1402 or request an appointment. Our Howell and Bloomfield Hills offices reserve same-day slots for urgent foot and ankle issues.
In Our Clinic: What We See
Clinical perspective from Dr. Tom Biernacki, DPM — Balance Foot & Ankle, Howell & Bloomfield Hills, MI:
Lisfranc injury is the most-missed foot injury in primary care and emergency rooms. Patients walk in weeks after a misstep complaining of midfoot pain that never resolves. In our clinic the first clue is often the bruising pattern — plantar bruising across the arch is pathognomonic. Weight-bearing X-rays comparing both feet reveal the widening that non-weight-bearing films miss. Non-displaced Lisfranc sprains can heal in a boot; any displacement requires surgery. Dr. Biernacki has handled dozens of missed Lisfranc injuries and always comments: if a midfoot sprain isn’t significantly better at 3 weeks, get weight-bearing films — don’t wait.
More Podiatrist-Recommended Ankle Sprain Essentials
Stability Walking/Running Shoe
- THIS MEN’S SHOE IS FOR: The Adrenaline GTS 25 is perfect for runners and walkers seeking reliable support and a smooth ride. Featuring holistic GuideRails for Go-To Support and soft, dynamic premium nitrogen-infused DNA LOFT v3 cushioning, it delivers distraction-free comfort mile after mile. This Brooks Adrenaline GTS 25 is a certified PDAC A5500 Diabetic shoe and has been granted the APMA Seal of Acceptance. Predecessor: Adrenaline GTS 24.
- GUIDERAILS HOLISTIC SUPPORT SYSTEM: Our innovative technology - known as “GTS” for “Go-To Support” - supports your body in its natural motion path while keeping excess movement in check.
- SOFT & DYNAMIC CUSHIONING: Even more premium nitrogen-infused DNA Loft v3 cushioning delivers lightweight softness, and feel-good comfort mile after mile.
- TRUSTED FIT: The breathable engineered mesh upper and flat-knit collar offer a secure, comfortable fit, providing both structure and flexibility to accommodate natural movement during active use.
- SMOOTH TRANSITIONS: The specially designed outsole and midsole work together to promote seamless transitions, ensuring comfort and support for every step, so you can stay active longer.
Brooks Adrenaline GTS 25 — lateral support during recovery walking.
KT Tape for Ankle Support
- Keep your feet healthy: Designed to help prevent blisters, chafing and hot spot formation so you can perform at your peak; Pre-cut strips offer quick application; Apply correctly with the KT App.
- Ultra-durable: 100% engineered synthetic fiber tape is specially designed to stand up to the rigors and harsh conditions facing runners, hikers, training athletes and dancers alike
- Stays in place: Blister Prevention Tape leverages KT’s advanced adhesive technology; Thin, comfortable material and a rounded edged design to stay on skin for up to two days
- Reduces friction: Designed ultra-light and thin to easily conform to skin and minimize blister-causing friction
- Good to your skin: Does not contain common materials that trigger allergic reactions; KT products are hypoallergenic, latex-free and naturally rubber-free
KT Tape — proprioceptive support for athletic return-to-play.
Supportive Insole
- The Pinnacle Full length insoles for men & women provide maximum cushioning, from high activity to moderate support. The PowerStep arch support shape provides stability to the foot and ankle, helping to relieve foot pain.
- When you spend all day on your feet, every step counts. PowerStep insoles are a podiatrist-recommended orthotic to help relieve & prevent foot pain related to athletes, runners, Plantar Fasciitis, heel spurs & other common foot, ankle & knee injuries
- The Pinnacle plantar fasciitis insoles offer superior heel cushioning and arch support. The dual-layer cushioning is designed to reduce stress and fatigue, while PowerStep premium arch support is designed for plantar fasciitis relief.
- The PowerStep Pinnacle arch support inserts for men & women can be worn in a variety of shoe types such as; athletic, walking, running, work & some casual shoes. Orthotic Inserts are ordered by shoe size, no trimming required.
- Made in the USA & backed by a 30-day money-back guarantee. PowerStep orthotic inserts for men & women are designed for shoes where the factory insole can be removed. HSA & FSA Eligible
PowerStep Pinnacle — arch support reduces re-injury risk during recovery.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
A sprain that hasn’t fully recovered after 6 weeks often has residual ligament laxity or occult fracture that keeps the ankle unstable. Balance Foot & Ankle X-rays and stress-tests every lingering sprain — if the ligament is torn, we offer bracing, PRP, and (for chronic instability) minimally-invasive repair. Don’t keep re-rolling the same ankle; let us stabilize it properly.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Watch: Dr. Tom explains
Podiatrist-recommended products
As an Amazon Associate, Dr. Tom earns from qualifying purchases.
Lisfranc immobilization.
View on Amazon →Midfoot arch support.
View on Amazon →Midfoot swelling.
View on Amazon →Graded weight bearing.
View on Amazon →Related resources
Ready to solve this? Book today.
Same-week appointments · Howell & Bloomfield Hills · 4.9★ (1,123+ reviews)
☎ (810) 206-1402Book Online →In-Office Treatment at Balance Foot & Ankle
When conservative care isn’t enough, Dr. Tom Biernacki and the team at Balance Foot & Ankle offer advanced, same-day options — including Foot & Ankle Fracture Repair Michigan at our Howell and Bloomfield Hills clinics.
Same-day appointments available. Call (810) 206-1402 or book online.
Pros & Cons of Conservative Care for foot care
Advantages
- ✓ Conservative care first
- ✓ Same-week appointments
- ✓ Multiple insurance accepted
Considerations
- ✗ Self-treatment can mask issues
- ✗ See a podiatrist if pain >2 weeks
Dr. Tom’s Recommended Products for foot care
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
Footnanny Heel Cream Dr. Tom’s Pick
Best for: Daily moisturizer for cracked heels
Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Twp. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
Book Today — Same-Day Appointments Available
Call Now: (810) 206-1402
About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Twp, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (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)