Lisfranc Injuries: What Athletes Need to Know

Lisfranc injuries are among the most commonly missed midfoot injuries in athletics, but they are far from inconsequential. When they do occur, Lisfranc injuries happen during high-impact and cutting movements, as well as during awkward landings. Learning how a Lisfranc injury happens, what it feels like, and how it can be treated, is an important part of keeping your midfoot safe and your long-term performance intact.

Let’s start with a brief review of the midfoot.

Midfoot Anatomy

The midfoot is comprised of a network of metatarsal and tarsal bones that form the core of the arch. Small but strong, these bones work together to absorb and transfer forces with every sprint, cutting maneuver, or rapid directional change. One particularly important ligament is the

Lisfranc ligament, which runs from the medial cuneiform to the second metatarsal. As the ligament that provides primary stability, it is the most likely to be injured when the midfoot is twisted or overloaded.

Midfoot integrity relies more heavily on ligamentous support, while having relatively little muscular reinforcement. As a result, it is more likely to become overloaded and injured when either experiencing twisting forces, such as cutting movements, or from a heavy impact.

Overloading the midfoot has the potential to shift the stability of the Lisfranc joint, which results in varying degrees of sprain, fracture, or dislocation. The risk of these types of injuries increases among athletes involved in cutting sports, field sports, and other sports that require high levels of rapid acceleration.

Two Kinds of Lisfranc Injuries

Broadly speaking, Lisfranc injuries fall into two categories: complete and incomplete. Complete Lisfranc injuries are characterized by both fracture and dislocation of the joint. This type of injury typically only happens in the event of high-energy trauma. Incomplete Lisfranc injuries can involve either a sprain or a fracture but without complete displacement of the joint. These distinctions have meaningful impact on treatment and recovery times.

Injuries to the second metatarsal also commonly occur, due to the fact that this bone plays such an important role in stabilizing the entire midfoot. Some external risk factors that influence the overall likelihood of a Lisfranc injury include poor footwear, unstable or uneven playing surfaces, overtraining, and poor biomechanics. Understanding the risk factors also helps athletes take action to prevent these injuries.

Causes and Key Risk Factors

A number of preexisting conditions can contribute to an athlete’s risk of Lisfranc injury. Certain structural differences in the foot, such as a higher arch or flatfoot, can increase stress on the midfoot during athletic movements. Worn out or poorly constructed footwear can also increase the midfoot’s instability, especially during sports with frequent changes of direction.

Preexisting injuries to the foot or ankle, as well as obesity or lack of conditioning, can also play a role. Fatigue from overtraining or pushing through injury, as well as a lack of recovery time, also leads to breakdown of technique and form.

Movements That Cause Injury

Cutting movements, change of direction maneuvers, vertical jumping and landings, and awkward landings all place a load on the midfoot. Basketball players are susceptible to Lisfranc injuries during sudden stops. Football players are vulnerable when tackling or during pileups, when another athlete may land on top of their foot.

Gymnasts, dancers, and martial artists all face an elevated risk of Lisfranc injuries due to the high repetition of stress, high-impact landings, and extreme foot placements inherent to these activities. These sports place high demands on precision but are also susceptible to injury when an athlete becomes fatigued or makes even a slight misstep, which can lead to a sudden overload on the midfoot.

Symptoms and Diagnosis

The most common symptom of a Lisfranc injury is severe pain in the midfoot area after the initial trauma has occurred. Weight-bearing is often difficult or impossible. Swelling, bruising, and tenderness may also develop on the arch. Occasionally, athletes report misalignment of the toes, especially the second toe, as a result of instability in the joint.

Diagnosis is time sensitive, and healthcare providers will typically begin with X-rays to assess the area. MRI or CT imaging can be helpful if soft tissue injury or more subtle fractures are suspected. Early detection and treatment is key to preventing long-term instability or chronic pain.

Treatment

Athletes with mild or stable Lisfranc injuries can often be treated without surgery by immobilizing the area in a cast or walking boot. Crutches are often provided to reduce load-bearing as the injury heals. Once an athlete is cleared, physical therapy can be used to gradually restore strength, mobility, and functional stability of the midfoot.

Severe injuries or injuries that involve fractures or significant joint displacement usually need surgical treatment. Screws or plates are used by surgeons to realign and stabilize the midfoot. Rehab usually begins following a period of initial healing, gradually working up to weight-bearing and sports-specific training.

Recovery and Return to Sport

The timeline for recovery and return to sport can vary quite a bit. Non-surgical cases will often take between 6-12 weeks of immobilization, followed by structured physical therapy. Athletes who have had surgery may need 4-6 months before they can return to low-impact activity, and often up to a year before they can safely return to high-impact sports.

Return-to-sport protocols gradually progress strength, agility, and functional movements. Confidence plays a critical role as well, and athletes often make use of sport psychology tools and techniques as they prepare to return to competition.

Prevention

Foot, ankle, and core strengthening can go a long way toward reducing the risk of injury. Calf raises, balance exercises, resistance band exercises, and plyometric work all help to prepare the midfoot for higher loads. Footwear is also important. Supportive, arch-supporting, and well-cushioned shoes help reduce the likelihood of a Lisfranc injury.

Frequently Asked Questions

How do I know if I have a Lisfranc injury?Severe midfoot pain following twisting, impact, or an awkward landing is the most common indicator that a Lisfranc injury has occurred. Other telling signs include the inability to bear weight and bruising on the arch.

Should I visit a sports medicine clinic for midfoot pain?Yes, absolutely. Too often, athletes in the Treasure Valley try to tough it out or wait until it’s too late. Prompt evaluation from a sports performance medicine provider can make a significant difference in long-term outcome.

How long until I can run again?Three months is often the earliest that mild cases can expect to return. Surgical cases will often require 6 months or more. Recovery is individualized, though.

Can improper footwear lead to Lisfranc injuries?Poor support and worn-out shoes both lead to increased instability, which can directly increase the risk of Lisfranc injuries for athletes playing high-impact sports.

Are Lisfranc injuries common in Boise and Meridian athletes?Yes, these types of injuries are relatively common among Boise and Meridian athletes. We frequently see athletes involved in football, trail running, basketball, and gymnastics with midfoot injuries, in part due to high training loads as well as local terrain.