Lisfranc Injury (Midfoot Fracture-Dislocation) | Treatment in SE Michigan

Quick answer: Treatment for lisfranc injury treatment michigan 2 follows a stepwise approach: 1) conservative care first (rest, ice, supportive footwear, OTC anti-inflammatories), 2) physical therapy and targeted exercises, 3) in-office treatments (injections, custom orthotics) if conservative fails at 4-6 weeks, 4) surgery for refractory cases. Most patients resolve at step 1 or 2. Call (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.

A Lisfranc injury involves damage to the ligaments and/or bones at the tarsometatarsal (TMT) joint complex — the joints in the midfoot where the metatarsal bones connect to the tarsal bones. These injuries range from a mild ligament sprain (low-energy, often from twisting) to a severe fracture-dislocation (high-energy, from falls or motor vehicle accidents). Lisfranc injuries are one of the most commonly missed diagnoses in foot and ankle medicine: subtle injuries frequently look normal on standard X-rays and are misdiagnosed as “just a foot sprain.” Undertreated Lisfranc injuries reliably progress to midfoot arthritis, flatfoot deformity, and chronic disability. At Balance Foot & Ankle in Southeast Michigan, Dr. Tom Biernacki has specific training in recognizing and treating the full spectrum of Lisfranc injuries.

Symptoms and Why They’re Often Missed

Lisfranc injuries cause pain and swelling across the top of the midfoot, frequently with bruising on the bottom of the foot near the arch (plantar ecchymosis — a very specific sign that should raise immediate concern for Lisfranc injury). The pain is worse with weight-bearing and there is point tenderness over the TMT joints. On standard non-weight-bearing X-rays, subtle Lisfranc injuries may appear normal or show only a small fleck fracture at the base of the second metatarsal (the “fleck sign”) — a ligament avulsion that indicates instability. Weight-bearing X-rays are essential: comparison of the first and second metatarsal-cuneiform alignment on weight-bearing films reveals instability that is not apparent at rest. CT scan provides excellent bony detail. MRI is the most sensitive study for ligamentous Lisfranc injuries in the absence of fracture.

Treatment: Surgical vs. Non-Surgical

True ligamentous Lisfranc injuries without fracture or instability on weight-bearing X-rays can be treated non-surgically: non-weight-bearing cast immobilization for 6 weeks followed by gradual return to weight-bearing with a rigid-soled boot and custom orthotics. This approach is appropriate only for stable, truly non-displaced injuries — a category that is smaller than many clinicians recognize. Any instability on weight-bearing imaging is a surgical indication. Surgical options include open reduction and internal fixation (ORIF) with plates and screws, and primary arthrodesis (fusion) of the medial column. Recent evidence favors primary arthrodesis for purely ligamentous injuries of the medial column, as it provides more reliable long-term outcomes than ORIF in this subset. Athletic patients with purely ligamentous injuries are a particular group where surgical decision-making is nuanced. Recovery after surgery typically involves 6–12 weeks of non-weight-bearing followed by progressive rehabilitation over 3–6 months.

Frequently Asked Questions

Midfoot injuries need expert evaluation — don’t let a Lisfranc injury be written off as a sprain. Contact Balance Foot & Ankle in Southeast Michigan for prompt evaluation with Dr. Biernacki.

Differential 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

In Our Clinic: What We See

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your foot fracture, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.

Frequently Asked Questions

How long does treatment take to work?

Most patients see improvement in 4-8 weeks with consistent conservative care. Persistent symptoms after 8 weeks need imaging and escalation.

When is surgery needed?

Surgery is reserved for cases that fail 3-6 months of conservative care, structural deformities, or fractures requiring stabilization.

Is this covered by insurance?

Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Custom orthotics often require diabetic or post-surgical justification.