Ross Hauser, MD; Danielle Matias, PA-C; Demi Foster, APRN

What is a Lisfranc injury?

A lisfranc injury simply refers to a “midfoot injury”. This can include a fracture or dislocation of bones of the midfoot or a ligament tear or sprain. The midfoot (essentially the “middle of your foot”) is where a group of small bones form the top arch of the foot. These bones are held together by multiple thick connective tissues (i.e. ligaments).

A lisfranc injury can occur by direct trauma to the foot or with a simple twist and fall (as can frequently happen with soccer players). After initial injury, the foot may be bruised, swollen, tender, and difficult to walk on. Bruising on the bottom of the foot after injury is typical of a lisfranc injury. Often, patients require crutches to avoid placing weight on their foot due to pain.

Lisfranc fracture: one or more of the bones in the midfoot is broken

• Lisfranc dislocation: one or more of the bones in the midfoot has become displaced
• Lisfranc tear: Complete tear: one or more of the ligaments in the midfoot is torn into two separate pieces, no longer connecting bones together
• Partial tear: one or more of the ligaments in the midfoot is torn, but remain in one piece
• Lisfranc sprain: Damage to one or more ligaments without any evident tear.

What are my treatment options?

Traditional treatments for Lisfranc injuries depend on their severity. Lisfranc bone fractures and complete ligament tears (where the ligament is torn into two separate pieces) may require immobilization and a non-weight bearing status (i.e. crutches) for optimal healing. Surgery may be necessary for severe cases, especially those involving multiple fractures, dislocations, or tears.

Traditional treatments for lisfranc sprains include rest, ice, and anti-inflammatory medication. Immobilization may also be recommended, which often requires the use of a “boot” or walking cast.

A January 2026 study in the journal Translational sports medicine (1) writes: “The Lisfranc ligamentous complex  plays a critical role in midfoot stability, and its disruption can result in significant long‐term morbidity if not promptly identified and managed. Accurate diagnosis requires a high index of suspicion, a meticulous physical examination, and weight‐bearing imaging. Subtle or missed injuries can lead to chronic pain, deformity, and functional impairment. . . Nonoperative treatment is reserved for nondisplaced injuries with intact joint alignment, while any evidence of instability or displacement warrants surgery.”

A December 2025 paper in the journal Knee surgery, sports traumatology, arthroscopy (2) “Experts unanimously agreed that stable, nondisplaced injuries with intact ligaments on MRI may be managed nonoperatively with close monitoring. Systematic review findings demonstrated that ligament injuries predominated in male athletes, with 96.8% returning to sport at 2.8 versus 4.5 months for bony injuries.”

An October 2025 paper in the journal Cureus (3) writes: “Conservative treatment for chronic injuries is generally palliative and includes custom orthotic devices with medial arch support and metatarsal pads, activity modification, anti-inflammatory medications, and corticosteroid injections for symptomatic arthritis. These measures may provide temporary relief but rarely result in long-term satisfaction.”

When surgery is being considered in elite athletes

Publishing in February 2026 in the journal Knee surgery, sports traumatology, arthroscopy (4) the international foot and ankle sports consensus committee issued their 2024 guidelines for Lis Franc treatments. The report notes: “Lisfranc injuries are potentially career-threatening for athletes, yet optimal management of unstable ligament and fracture-dislocation injury patterns remains debated.” To understand best surgical guidelines, the committee  evaluated current surgical strategies and outcomes, aiming to establish evidence-based recommendations for treatment.

A systematic review evaluated post-operative outcomes following suture button fixation (SBF), open reduction internal fixation (ORIF) and arthrodesis of unstable ligament and fracture-dislocation Lisfranc injuries. In addition, a consensus was conducted by an initial survey sent to the expert panel. General consensus was defined as 75%-85% agreement, strong consensus as 86%-99% agreement and unanimous consensus as 100% agreement.

Conclusion: “Elite athletes who present with unstable ligament Lisfranc injuries and indications for surgical intervention should undergo fixation rather than fusion. For bony and fracture-dislocation Lisfranc injuries, open reduction internal fixation (ORIF) is preferred when joint surfaces are salvageable and arthrodesis when long-term preservation is not feasible.”

Return to sports

In a separate report (5) the international foot and ankle sports consensus committee also reviewed the athletes return to sport. “. . . most athletes progress to full weightbearing by 8-12 weeks and return-to-sport within 4-6 months postoperatively. Over 90% of athletes successfully resumed play, underscoring the effectiveness of structured, phase-based rehabilitation. ”

However, a December 2025 study (6)  from Turkish doctors wrote: “Patients with surgically treated Myerson type B Lisfranc injuries exhibit persistent deficits in ankle dorsiflexion Range-of-motion and in isokinetic strength and endurance of both dorsiflexion and plantarflexion, despite favorable clinical scores and radiographic outcomes.”

Prolotherapy for Lisfranc injuries

If you have a true Lisfranc fracture, immobilization is still the best way to heal the broken bone. However, once the bone is healed and if you are still left with chronic foot pain, it may be due to underlying joint instability due to ligament injury. Why is that? Think about it – If you receive enough trauma to your midfoot that causes a bone to break, it is not hard to understand that the surrounding tissues also received the same force, making it likely that you also suffered a concurrent ligament tear or sprain as well.

While bones heal well with immobilization, ligaments do not. This is why people often continue to experience pain after suffering a broken bone; they are still left with an underlying ligament injury and joint instability. Even “simple” lisfranc sprains or partial ligament tears can leave someone with chronic foot pain and unsolved joint instability in the midfoot. A great treatment for ligament injuries to the foot is Prolotherapy to stimulate healing and repair.

Prolotherapy, also known as a regenerative injection technique, works to heal injured tissue by the induced proliferation of new cells. If you have suffered a Lisfranc injury and still have chronic foot pain, Prolotherapy may be a good treatment option for you. The team at our Florida treatment center would be happy to talk with you to discern if your case would be a good fit for our clinic. Please understand that we cannot take all cases. We wish you all the best in health and getting to the bottom of your foot pain!

Read our published research

Evidence-Based Use of Dextrose Prolotherapy for Musculoskeletal Pain: A Scientific Literature Review: This paper has been cited by 45 research studies as we were able to demonstrate level 1 and 2 evidence to support the use of dextrose Prolotherapy for osteoarthritic pain and function, tendinopathies, myofascial pain syndrome, sacroiliac pain, and myofascial pain syndrome. There is level 3 evidence in support of the use of dextrose Prolotherapy for diffuse muscusloskeletal pain involving the spine, pelvis and peripheral joints. Dextrose Prolotherapy should be recommended for such musculoskeletal conditions as tendinopathy, ligament sprains, Osgood-Schlatter disease and degenerative joint disease, including osteoarthritis.

References

1 Hammad A, Ahmad Y, Abdelnour J. Lisfranc Injuries: Latest Updates on Diagnostics and Management. Translational Sports Medicine. 2026;2026(1):3933956. [Google Scholar]
2 Semelsberger SD, Boggiano VJ, Webber K, Balboni JM, Butler J, Levine AR, IFASC Committee, Abhishek K, Anderson R, Andersen M, Batista J. Diagnostic evaluation and nonoperative management of Lisfranc injuries in athletes. Knee Surgery, Sports Traumatology, Arthroscopy. 2025 Dec 26. [Google Scholar]
3 Mohamed A, Elasad A, Khan AU, Fuad U, Salib P, KHAN AU. From Missed Diagnosis to Optimal Outcomes: A Comprehensive Review of Lisfranc Injuries. Cureus. 2025 Oct 15;17(10). [Google Scholar]
4 Webber KJ, Balboni JM, Semelsberger SD, Boggiano VJ, Levine AR, Butler J, Gianakos AL, IFASC Committee. Return to sport following Lisfranc injuries in elite athletes—2024 international foot and ankle sports consensus and systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. [Google Scholar]
5 Webber KJ, Balboni JM, Semelsberger SD, Boggiano VJ, Levine AR, Butler J, Gianakos AL, IFASC Committee. Return to sport following Lisfranc injuries in elite athletes—2024 international foot and ankle sports consensus and systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. [Google Scholar]
6 Demirel M, Karaçam Mİ, Ayan MO, Şahinkaya T, Utlu DK, Polat G. Reduced ankle strength and dorsiflexion joint motion after surgical treatment of Myerson type b Lisfranc injuries: A controlled study. Acta Orthopaedica et Traumatologica Turcica. 2025 Dec 31;59(6):405. [Google Scholar]