A Lisfranc injury — sprain or fracture of the tarsometatarsal joint complex — is one of the most-missed foot injuries. Catching it early changes everything about treatment and outcome.
You’re in the right place. Dr. Tom Biernacki, DPM, FACFAS — board-certified foot & ankle surgeon with 3,000+ surgeries — explains exactly what Lisfranc injury surgery means and what works. Call (810) 206-1402 for same-day appointment at Howell or Bloomfield Hills.
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Quick Answer
Most foot and ankle problems respond to conservative care — proper footwear, supportive inserts, activity modification, and targeted stretching — within 4-8 weeks. Persistent pain beyond that window, or any symptom that prevents walking, warrants a podiatric evaluation to rule out fracture, tendon tear, or systemic cause.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
Watch: Dr. Tom Biernacki, DPM
Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: April 4, 2026
QUICK ANSWER
Lisfranc injuries are tarsometatarsal joint fracture-dislocations that are frequently misdiagnosed as sprains. Unstable injuries require surgery—either ORIF (open reduction internal fixation) or primary fusion. Recovery takes 4-6 months, and missed or poorly treated injuries lead to post-traumatic arthritis.
What Is a Lisfranc Injury?
A Lisfranc injury is a disruption of the tarsometatarsal (TMT) joint complex — the articulation between the tarsal bones (navicular, cuneiforms, and cuboid) and the bases of the five metatarsals at the midfoot. The complex is named for French surgeon Jacques Lisfranc de St. Martin, who described midfoot amputations at this level in Napoleonic War cavalry soldiers injured when their foot was caught in a stirrup during a fall. These injuries range from purely ligamentous sprains to complete fracture-dislocations involving all five TMT joints.
At Balance Foot & Ankle, our Michigan foot surgeons manage Lisfranc injuries across the full spectrum of severity, from conservative treatment of stable ligamentous injuries to complex surgical reconstruction of displaced fracture-dislocations.
Why Lisfranc Injuries Are Frequently Missed
Lisfranc injuries are the most commonly missed foot injury in emergency medicine. The midfoot is often not specifically examined after foot trauma, and non-weight-bearing X-rays frequently appear normal in ligamentous Lisfranc injuries because the diastasis (widening between bones) only appears under load. The diagnostic key is weight-bearing radiographs of the foot. A gap of 2 millimeters or more between the medial and middle cuneiforms, or between the first and second metatarsal bases, indicates significant ligamentous disruption requiring treatment. Any patient with midfoot pain and bruising on the plantar surface of the foot after trauma should have weight-bearing X-rays if their condition permits.
When Lisfranc Surgery Is Indicated
Unstable Lisfranc injuries — those with displacement of 2 millimeters or more on weight-bearing radiographs, or complete dislocation of the TMT joints — require surgical stabilization. Purely ligamentous injuries with displacement require surgery because the midfoot ligaments heal poorly once disrupted under the loading forces of normal gait. Bony Lisfranc injuries with displaced fracture fragments also require ORIF or primary fusion to restore TMT joint alignment and prevent progressive deformity.
ORIF Versus Primary Fusion
Two surgical approaches exist for Lisfranc injury stabilization. Open reduction and internal fixation (ORIF) uses screws or bridge plates to reduce the displaced joints and hold them in anatomic position while the ligaments heal, with hardware removal planned at 3 to 4 months. Primary arthrodesis (fusion) of the medial column TMT joints — first, second, and sometimes third TMT joints — is increasingly preferred for purely ligamentous injuries because the fusion achieves more reliable long-term stability than ligament healing over ORIF hardware. Several prospective trials have demonstrated superior outcomes with primary fusion compared to ORIF for ligamentous Lisfranc injuries.
Recovery After Lisfranc Surgery
Non-weight bearing for 6 to 8 weeks is the standard post-operative protocol for both ORIF and primary fusion. Progressive weight bearing in a CAM boot begins at 8 to 10 weeks as radiographic healing progresses. Return to low-impact activity typically occurs at 4 to 6 months. Return to running and high-impact activities may require 6 to 12 months. Hardware from ORIF is removed at 3 to 4 months to prevent screw breakage from continued midfoot loading. Long-term outcomes after appropriate surgical treatment are significantly better than after conservative management of unstable injuries — return to full pre-injury activity is achievable for most patients.
If you have midfoot pain after a twisting or crush injury, contact Balance Foot & Ankle for evaluation including weight-bearing X-rays. Missed Lisfranc injuries cause progressive midfoot arthritis that is far harder to treat than acute injury. We serve Southeast Michigan with same-week appointments.
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Board-certified podiatrists serving Southeast Michigan. Same-week appointments available.
Warning
Lisfranc injuries are missed in up to 20% of initial evaluations because subtle ligament injuries may not show on standard X-rays. If midfoot pain and swelling persist after a ‘sprain’ diagnosis, insist on weight-bearing X-rays, CT, or MRI to rule out Lisfranc injury.
Frequently Asked Questions
When should I see a podiatrist?
If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).
What does treatment cost?
Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
What is Metatarsalgia?
Metatarsalgia is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.
Symptoms and warning signs
Common signs of metatarsalgia include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.
Conservative treatment options
Most cases of metatarsalgia respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.
When is surgery considered?
Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.
Recovery timeline and prevention
Recovery from metatarsalgia varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.
Ready to feel better?
Same-week appointments available in Howell and Bloomfield Hills, Michigan.
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In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your metatarsalgia, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
Same-day appointments available. (810) 206-1402
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Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.