Why Lisfranc Injuries Are Such a Big Deal in Athletes

DR. SARANG DESAI / DEEP DIVE

The Most Misunderstood Foot Injury in Sports

BY DR. SARANG DESAI | Fellowship-Trained Orthopedic Surgeon | Dallas–Fort Worth

You've probably never heard of the Lisfranc joint. But if you're an athlete — or you follow professional sports — there's a good chance you've seen a career derailed by an injury to it.

Lisfranc injuries are one of the most commonly missed, most frequently misdiagnosed, and most consequential foot injuries in all of sports. Up to one-third of these injuries are initially missed on standard X-rays. When they are missed, the consequences can be devastating: chronic pain, midfoot collapse, arthritis, and in some cases, the end of an athletic career.

This article is a deep dive into everything you need to know about Lisfranc injuries — what they are, why they matter so much in athletes, which professional athletes have been affected, how they're diagnosed, how they're treated, and what the latest research says about getting back to sport.

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PATIENT GUIDE

Key Takeaways

- The Lisfranc joint is the critical connection between the midfoot and forefoot. It's essential for push-off, cutting, sprinting, and virtually every athletic movement.

- Lisfranc injuries are missed in up to 20–33% of cases on initial evaluation, making them one of the most commonly misdiagnosed injuries in emergency medicine and sports medicine.

- Missed Lisfranc injuries are among the most common causes of malpractice litigation against radiologists and emergency department physicians.

- In professional football, 83% of NFL players returned to play after Lisfranc injuries, but they missed a median of 11 months and experienced measurable declines in performance.

- The 2024 International Foot and Ankle Sports Consensus (IFASC) — involving 32 international foot and ankle surgeons — established the first evidence-based guidelines for diagnosing and managing Lisfranc injuries in elite athletes.

- Stable, nondisplaced injuries with intact ligaments on MRI can be treated without surgery, with most athletes returning to sport within 6 to 10 weeks.

- Unstable injuries require surgery. The expert consensus unanimously agreed that athletes can expect to return to sport 4 to 6 months after surgical fixation.

- Over 90% of athletes who undergo treatment for Lisfranc injuries successfully return to sport.

- Long-term, post-traumatic arthritis develops in up to 54% of surgically treated patients, though not all are symptomatic.

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PATIENT GUIDE

What Is the Lisfranc Joint?

The Lisfranc joint — also called the tarsometatarsal (TMT) joint — is where the long bones of your forefoot (the metatarsals) connect to the small bones of your midfoot (the cuneiforms and cuboid). Think of it as the bridge between the front and middle of your foot.

This joint isn't just one connection. It's actually a complex of multiple joints and ligaments that work together to provide stability and allow your foot to transfer force from your leg to the ground.

The most important structure in this complex is the Lisfranc ligament — a thick, powerful band of tissue that connects the medial cuneiform bone to the base of the second metatarsal. Research has shown that this ligament is actually made up of three distinct components:

- The interosseous ligament — the largest and strongest of the three, with the highest stiffness and resistance to failure

- The plantar ligament — located on the bottom of the foot

- The dorsal ligament — the thinnest and weakest, located on top of the foot

The interosseous Lisfranc ligament is the keystone of midfoot stability. When it tears, the entire architecture of the foot can become unstable.

Why does this matter for athletes?

Every time you push off, sprint, cut, jump, or land, enormous forces travel through the Lisfranc joint. It's the critical link in the chain that allows your foot to act as a rigid lever during push-off. When this joint is disrupted, the foot loses its ability to efficiently transfer power — and that's why Lisfranc injuries are so devastating for athletes who depend on explosive movements.

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DEEP DIVE

Why Are Lisfranc Injuries Such a Big Deal?

There are several reasons why Lisfranc injuries stand apart from other foot injuries in athletes:

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1. They're Frequently Missed

This is the single biggest problem with Lisfranc injuries. They are misdiagnosed in approximately 20% of cases, and some studies report that up to one-third are initially missed. Missed Lisfranc injuries are among the most common causes of litigation against radiologists and emergency department physicians.

Why are they missed so often?

- The findings on standard X-rays can be extremely subtle — sometimes just a 1 to 2 millimeter widening between bones

- In athletes, the injury is often a low-energy "sprain" rather than an obvious fracture-dislocation

- Swelling and pain may prevent a thorough physical exam

- The injury can be overshadowed by other injuries

- Many clinicians simply aren't thinking about it

The classic scenario: an athlete twists their foot, goes to the emergency room, gets X-rays that look "normal," is told they have a "midfoot sprain," and is sent home in a walking boot. Weeks later, they're still in pain, can't push off, and an MRI or CT scan finally reveals the Lisfranc injury that was there all along.

By that point, the window for optimal treatment may have narrowed.

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2. Delayed Diagnosis Leads to Worse Outcomes

Research consistently shows that the quality of the initial reduction — meaning how well the bones are put back in their correct position — is the single most important factor in determining long-term outcomes. When diagnosis is delayed, swelling increases, the injury may worsen, and achieving a perfect reduction becomes more difficult.

A long-term study in the Journal of Bone and Joint Surgery followed patients for an average of nearly 11 years after surgical treatment and found that 72% developed radiographic evidence of osteoarthritis, with 54% developing symptomatic arthritis. The strongest risk factor for arthritis? Nonanatomic reduction — meaning the bones weren't perfectly realigned.

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3. The Consequences of Getting It Wrong Are Severe

A missed or poorly treated Lisfranc injury can lead to:

- Chronic midfoot pain that doesn't respond to rest or therapy

- Midfoot collapse and flatfoot deformity — the arch literally falls apart

- Post-traumatic arthritis — often requiring fusion surgery years later

- Inability to push off or cut — career-ending for athletes

- Chronic instability — the foot never feels "right"

This is why orthopedic surgeons take Lisfranc injuries so seriously. A stress fracture will heal. An ankle sprain will usually recover. But a missed Lisfranc injury can permanently alter the biomechanics of the foot.

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DEEP DIVE

How Do Lisfranc Injuries Happen in Athletes?

The typical mechanism in sports is an axial load through a plantarflexed foot — meaning force is driven straight down through the foot while the toes are pointed downward. This can also involve a twisting component.

Common scenarios include:

- Football: A lineman's foot is planted and another player falls on the back of the heel, driving force through the midfoot. Or a player steps on another player's foot while the foot is flexed.

- Soccer: Landing awkwardly from a header or tackle with the foot pointed down

- Basketball: Landing on another player's foot after a rebound

- Running/trail sports: Catching the foot in a hole or on uneven terrain

- Dance/gymnastics: Landing from a jump with the foot in a pointed position

- Equestrian sports: The injury is actually named after Jacques Lisfranc de St. Martin, a French surgeon in Napoleon's army who described it in cavalry soldiers whose feet got caught in stirrups during falls from horses

The key point: you don't need a massive, high-energy trauma to sustain a Lisfranc injury. In athletes, these are often low-energy injuries that look like simple sprains — which is exactly why they get missed.

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DEEP DIVE

Professional Athletes Who Have Suffered Lisfranc Injuries

Lisfranc injuries have affected some of the biggest names in professional sports. These cases illustrate just how significant this injury can be — even with access to the best medical care in the world.

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Football (NFL)

Lisfranc injuries are particularly common in football. Research has identified 35 NFL players with documented Lisfranc injuries over a single study period, with 83% returning to play at a median of 11.1 months from injury. However, the data tell a more nuanced story: NFL players started fewer games in the second and third seasons after injury, and offensive players experienced a 21% decline in statistical performance compared to pre-injury levels.

Notable NFL players affected by Lisfranc injuries include:

- Matt Leinart — The former USC Heisman Trophy winner and Arizona Cardinals quarterback suffered a Lisfranc injury that contributed to the decline of his NFL career

- Darren McFadden — The Oakland Raiders running back sustained a Lisfranc injury in 2013 that significantly impacted his ability to cut and accelerate

- Ryan Mathews — The San Diego Chargers running back missed significant time with a Lisfranc injury

- Santonio Holmes — The New York Jets wide receiver and Super Bowl MVP suffered a Lisfranc injury that effectively ended his career

- Deion Branch — The New England Patriots wide receiver dealt with a Lisfranc injury during his career

The research shows that offensive players — particularly running backs and wide receivers who depend on cutting, acceleration, and explosive push-off — are disproportionately affected by performance declines after Lisfranc injuries compared to defensive players.

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Soccer

A study of 17 elite professional soccer and rugby players in the English Premier League and Championship leagues found that all had unstable Lisfranc injuries requiring surgery. Of these, 16 of 17 returned to full competition — but one athlete retired. The mean time to return to full competition for soccer players was 24.1 weeks (about 6 months).

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Other Sports

Lisfranc injuries have been reported across virtually every sport that involves running, cutting, or jumping — including basketball, baseball, tennis, gymnastics, and dance. The injury doesn't discriminate by sport; it discriminates by mechanism.

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PATIENT GUIDE

Symptoms: What Does a Lisfranc Injury Feel Like?

The symptoms of a Lisfranc injury can range from subtle to obvious, depending on the severity:

Mild (subtle/low-grade) injuries:

- Pain and swelling across the top of the midfoot

- Pain that worsens with pushing off or going up on your toes

- Difficulty bearing weight

- A feeling that the foot "isn't right" — even though X-rays may look normal

Moderate to severe injuries:

- Significant swelling across the entire midfoot

- Plantar ecchymosis — bruising on the bottom of the foot (this is a classic warning sign)

- Inability to bear weight

- Visible deformity in severe cases

- Pain with any attempt to push off

The red flag that should never be ignored: Bruising on the bottom of the midfoot after a foot injury is highly suspicious for a Lisfranc injury until proven otherwise. If you see this sign, advanced imaging is essential.

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PATIENT GUIDE

Diagnosis: How Are Lisfranc Injuries Found?

Accurate diagnosis requires a combination of clinical suspicion, physical examination, and appropriate imaging.

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Physical Examination

The 2024 International Foot and Ankle Sports Consensus reached unanimous agreement on the key clinical findings:

- Midfoot tenderness — pain when pressing on the top of the midfoot, particularly over the Lisfranc joint

- Pain with the squeeze test — compressing the forefoot causes pain at the midfoot

- Inability to bear weight or pain with single-leg heel rise

- Piano key test — grasping individual metatarsals and moving them up and down to assess for instability and pain

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Imaging

Bilateral weight-bearing X-rays are the first-line imaging study. The key is that they must be weight-bearing (standing) and bilateral (both feet) so the injured side can be compared to the normal side. The most important finding is widening of the space between the base of the first and second metatarsals or between the medial cuneiform and the second metatarsal base.

The following figure demonstrates the critical alignment that must be assessed on X-rays — even subtle malalignment can indicate a significant injury.

Figure 2 Anteroposterior view showing alignment of the lateral borders of the first metatarsal and the medial cuneiform as well as the medial borders of the second metatarsal and the middle cuneiform.

CT scan provides excellent detail of the bony anatomy and can detect fractures and subtle displacement that X-rays miss. Three-dimensional CT reconstructions have shown excellent diagnostic reliability, with sensitivity and specificity ranging from 92% to 97%.

MRI is the best study for evaluating the Lisfranc ligament itself and detecting purely ligamentous injuries without fracture. The 2024 consensus recommends MRI specifically for evaluating low-grade instability when X-rays and CT are inconclusive.

The bottom line on imaging: If there is clinical suspicion for a Lisfranc injury and standard X-rays look normal, do not stop there. Advanced imaging with CT or MRI is essential. This is where most missed diagnoses occur.

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DEEP DIVE

Classification: Not All Lisfranc Injuries Are the Same

Modern classification has moved away from purely anatomy-based systems toward a stability-based approach, which is more useful for guiding treatment:

Stable injuries:

- No displacement on weight-bearing X-rays

- Intact Lisfranc ligament on MRI

- The foot maintains its normal alignment under load

Unstable injuries:

- Displacement visible on weight-bearing X-rays or CT

- Torn or disrupted Lisfranc ligament

- The foot cannot maintain normal alignment

This distinction is critical because it determines whether surgery is needed.

Injury patterns are also classified by type:

- Ligamentous injuries — the ligament tears without a fracture (more common in athletes)

- Bony injuries — fractures through the bones at the Lisfranc joint

- Fracture-dislocations — the most severe pattern, with both fractures and complete joint displacement

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PATIENT GUIDE

Treatment: How Are Lisfranc Injuries Managed?

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Nonoperative Treatment (For Stable Injuries)

The 2024 International Foot and Ankle Sports Consensus unanimously agreed that stable, nondisplaced injuries with intact ligaments on MRI can be managed without surgery. Treatment typically includes:

- Non-weight-bearing in a cast or boot for 4 to 6 weeks

- Close monitoring with repeat imaging to ensure the injury remains stable

- Gradual progression to weight-bearing

- Physical therapy and rehabilitation

- Return to sport within 6 to 10 weeks for most athletes with stable ligament injuries

The key word is close monitoring. Even injuries that initially appear stable can displace over time. Serial weight-bearing X-rays are essential to catch any progression before it becomes a bigger problem.

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Surgical Treatment (For Unstable Injuries)

Unstable Lisfranc injuries require surgery to restore normal alignment. The quality of the reduction — how precisely the bones are put back in place — is the single most important factor in determining long-term outcomes.

Surgical options include:

Open Reduction and Internal Fixation (ORIF) — The traditional approach. The joint is opened, the bones are reduced to their anatomic position, and screws or plates are used to hold everything in place. This remains the most common technique. However, hardware removal is frequently needed — in one large study, 93.5% of reoperations after ORIF were for hardware removal.

Suture Button Fixation (SBF) — A newer technique that uses flexible fixation rather than rigid screws. The 2024 consensus systematic review found that for unstable ligament injuries, suture button fixation showed higher functional scores (AOFAS 95.5 vs. 89.4), lower complication rates (10.9% vs. 18.2%), zero failures (vs. 4.9% for ORIF), and no secondary procedures (vs. 30.5% for ORIF). This is an exciting development, though more long-term data are needed.

Primary Arthrodesis (Fusion) — In this procedure, the damaged joints are permanently fused together rather than repaired. The 2024 expert consensus unanimously agreed that for unstable ligament injuries in athletes, fixation is preferred over fusion — preserving motion is important for athletic performance. However, for fracture-dislocation patterns where the joint surfaces are too damaged to salvage, arthrodesis may be the better option.

The consensus was clear: the choice between fixation and fusion should be individualized based on the injury pattern, the condition of the joint surfaces, and the athlete's goals.

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PATIENT GUIDE

Recovery Timeline: What to Expect

Recovery from a Lisfranc injury follows a structured, phase-based progression. The 2024 International Foot and Ankle Sports Consensus established the following milestones:

Weeks 0–6:

- Non-weight-bearing in a cast or boot

- Focus on swelling control and pain management

- Gentle range-of-motion exercises for the ankle and toes (not the midfoot)

Weeks 6–12:

- Gradual progression to full weight-bearing (typically achieved by 8 to 12 weeks for unstable ligament injuries)

- Begin physical therapy

- Stationary cycling and pool exercises

Months 3–4:

- Progressive strengthening

- Sport-specific conditioning begins

- Jogging on flat surfaces if pain-free

Months 4–6:

- Return to sport-specific training

- Cutting, jumping, and agility drills

- The 2024 consensus unanimously agreed that athletes can expect to return to sport 4 to 6 months postoperatively

Important context: While the consensus timeline is 4 to 6 months, real-world data show significant variability. In the NFL, the median return was 11.1 months. In elite soccer, it was approximately 6 months. The mean time to return to sport for ligamentous injuries across all studies was 8.9 months. These differences reflect the varying demands of different sports and the severity of individual injuries.

A meta-analysis found that 93% to 94% of athletes return to some level of sport, and 74% to 88% return to their pre-injury level — depending on the treatment method.

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DEEP DIVE

The Performance Question: Do Athletes Come Back the Same?

This is the question every athlete wants answered — and the honest answer is: it depends.

The good news:

- Over 90% of athletes return to sport after Lisfranc injuries

- In the NFL, 92.9% returned to competition

- In elite soccer and rugby, 94% returned to full competition

The concerning data:

- NFL players started fewer games in the second and third seasons after injury

- Offensive players (running backs, wide receivers) experienced a 21% decline in statistical performance one season after return

- Offensive players had significantly greater performance declines than defensive players — likely because offensive positions demand more explosive push-off, cutting, and acceleration

- One study found that while performance declines were observed, they did not reach statistical significance compared to age-matched controls — suggesting that some decline may be attributable to normal aging and career trajectory rather than the injury alone

The bottom line for athletes: Most athletes do return to sport after a Lisfranc injury. But for positions that demand explosive foot mechanics — running backs, wide receivers, soccer forwards, basketball guards — there is a real risk of measurable performance decline. This is why accurate diagnosis, anatomic reduction, and structured rehabilitation are so critical.

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PATIENT GUIDE

Long-Term Outlook: What Happens Years Later?

The most significant long-term concern after a Lisfranc injury is post-traumatic arthritis.

A study in the Journal of Bone and Joint Surgery with follow-up averaging nearly 11 years found:

- 72% of patients developed radiographic evidence of osteoarthritis

- 54% developed symptomatic arthritis (meaning it actually caused pain and functional limitations)

- Risk factors for arthritis included nonanatomic reduction, more severe injury patterns (Myerson type C), and smoking

- Despite the high rate of arthritis, overall functional scores were satisfactory, and most patients returned to their previous level of functioning

A separate study with 14 years of follow-up found that while radiographic arthritis was common, there was a poor correlation between the severity of arthritis on X-rays and actual symptoms — meaning many patients with arthritis on imaging were doing well clinically.

For athletes, this means:

- Getting the initial treatment right is paramount — anatomic reduction reduces the risk of arthritis

- Some degree of arthritis is likely over time, but it may not be symptomatic

- If symptomatic arthritis does develop years later, salvage fusion surgery can still provide good pain relief and function

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PATIENT GUIDE

Frequently Asked Questions

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What is a Lisfranc injury?

A Lisfranc injury is damage to the bones, ligaments, or both at the tarsometatarsal joint — the connection between the midfoot and forefoot. It can range from a mild ligament sprain to a complete fracture-dislocation. The injury is named after Jacques Lisfranc de St. Martin, a French military surgeon who first described it in the early 1800s.

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Why are Lisfranc injuries so commonly missed?

The findings on standard X-rays can be extremely subtle. In athletes, the injury often presents as what appears to be a simple "midfoot sprain." Up to one-third of cases are initially missed. Weight-bearing X-rays, CT scans, and MRI are often needed to make the diagnosis.

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How do I know if I have a Lisfranc injury versus a regular midfoot sprain?

The key warning signs are: inability to bear weight, pain with push-off, bruising on the bottom of the foot (plantar ecchymosis), and persistent midfoot pain that doesn't improve with rest. If you have any of these after a foot injury, you should be evaluated by an orthopedic surgeon — not just treated as a sprain.

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Can a Lisfranc injury heal without surgery?

Yes — but only if the injury is stable. Stable injuries with intact ligaments on MRI and no displacement on weight-bearing X-rays can be treated with immobilization and close monitoring. Unstable injuries require surgery.

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What surgery is done for a Lisfranc injury?

The most common procedures are open reduction and internal fixation (ORIF) with screws or plates, suture button fixation, or primary arthrodesis (fusion). The choice depends on the injury pattern and the condition of the joint surfaces. For athletes with ligament injuries, fixation (not fusion) is generally preferred.

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How long does it take to return to sport after a Lisfranc injury?

The 2024 international expert consensus agreed on a 4 to 6 month timeline for return to sport after surgery. Real-world data show averages ranging from 6 to 11 months depending on the sport and severity. Over 90% of athletes successfully return.

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Will I be the same athlete after a Lisfranc injury?

Most athletes return to sport, but research in NFL players shows measurable performance declines — particularly for offensive skill positions. The quality of the initial surgical reduction and the rehabilitation program are the most important factors in maximizing recovery.

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What is plantar ecchymosis and why does it matter?

Plantar ecchymosis is bruising on the bottom of the foot. It's a classic warning sign of a Lisfranc injury because it indicates bleeding from disrupted ligaments or fractures deep in the midfoot. If you see bruising on the sole of your foot after an injury, seek evaluation immediately.

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Do I need hardware removed after Lisfranc surgery?

If screws are used, hardware removal is common — in one study, over 90% of reoperations after ORIF were for hardware removal, typically performed around 4 months after surgery. Suture button fixation may reduce the need for hardware removal.

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Can a Lisfranc injury end a career?

It can, but it's uncommon with proper treatment. In the NFL, only about 7% of players with Lisfranc injuries never returned to competition. However, the injury can accelerate career decline, particularly for positions that demand explosive foot mechanics.

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What happens if a Lisfranc injury is missed?

A missed Lisfranc injury can lead to chronic pain, midfoot instability, arch collapse, and post-traumatic arthritis. Delayed treatment is associated with worse outcomes. If you've had persistent midfoot pain after a foot injury that was initially diagnosed as a "sprain," consider getting a second opinion with advanced imaging.

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Is a Lisfranc injury the same as a Jones fracture?

No. A Jones fracture occurs at the base of the fifth metatarsal (the outside of the foot), while a Lisfranc injury involves the tarsometatarsal joint complex (the middle of the foot). Both are serious injuries in athletes, but they involve different anatomy and different treatment approaches.

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PATIENT GUIDE

Myth vs. Fact

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MYTH — A Lisfranc injury is just a bad midfoot sprain.

FACT — A Lisfranc injury involves disruption of the critical ligaments and/or bones that hold the midfoot together. Unlike a simple sprain, an unstable Lisfranc injury will not heal properly without surgery. Calling it a "sprain" is one of the main reasons these injuries get missed and undertreated.

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MYTH — If the X-ray looks normal, there's no Lisfranc injury.

FACT — Standard X-rays miss Lisfranc injuries in up to one-third of cases. Weight-bearing X-rays, CT scans, and MRI are often needed to detect subtle injuries. A normal-looking X-ray does not rule out a Lisfranc injury.

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MYTH — You can play through a Lisfranc injury.

FACT — Playing through an unstable Lisfranc injury risks worsening the displacement, increasing damage to the joint surfaces, and dramatically increasing the risk of long-term arthritis and disability. This is not an injury you can "tough out."

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MYTH — Lisfranc injuries only happen in high-energy accidents.

FACT — In athletes, Lisfranc injuries are often caused by relatively low-energy mechanisms — a twist, a misstep, landing on a pointed foot. The injury doesn't have to be dramatic to be serious.

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MYTH — All Lisfranc injuries need surgery.

FACT — Stable, nondisplaced injuries with intact ligaments on MRI can be treated without surgery. The 2024 international consensus confirmed that nonoperative management is appropriate for truly stable injuries, with most athletes returning to sport within 6 to 10 weeks.

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MYTH — Fusion surgery means the end of an athletic career.

FACT — While fixation (preserving the joint) is preferred for athletes with ligament injuries, fusion can still produce good functional outcomes when the joint surfaces are too damaged to save. Some athletes have returned to high-level sport even after fusion procedures.

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MYTH — If you can walk on it, it's not a Lisfranc injury.

FACT — Many athletes with subtle Lisfranc injuries can still walk — they just can't push off, sprint, or cut without pain. The ability to walk does not rule out a significant injury. This is similar to how some patients can walk on a torn Achilles tendon — walking ability alone doesn't determine injury severity.

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MYTH — Recovery from Lisfranc surgery is quick.

FACT — Even with optimal treatment, return to sport typically takes 4 to 11 months depending on the sport and severity. This is a significant injury with a significant recovery. Rushing back increases the risk of re-injury and long-term complications.

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EVIDENCE REVIEW

Research Summary

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THE 2024 INTERNATIONAL FOOT AND ANKLE SPORTS CONSENSUS ESTABLISHED THE FIRST EVIDENCE-BASED GUIDELINES.

A panel of 32 international foot and ankle surgeons used a modified Delphi process to establish consensus guidelines for diagnosing, treating, and returning athletes to sport after Lisfranc injuries. This landmark effort produced unanimous or strong consensus on diagnostic criteria, nonoperative management, surgical techniques, and return-to-sport timelines.

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LISFRANC INJURIES ARE MISSED IN UP TO ONE-THIRD OF CASES.

Multiple studies confirm that these injuries are frequently misdiagnosed on initial evaluation. Missed Lisfranc injuries are among the most common causes of malpractice litigation against radiologists and emergency physicians. Weight-bearing X-rays and advanced imaging are essential for accurate diagnosis.

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NFL DATA SHOW HIGH RETURN RATES BUT MEASURABLE PERFORMANCE DECLINES.

A study of 28 NFL athletes found that 92.9% returned to competition at a median of 11.1 months. However, offensive players experienced a 21% decline in statistical performance. A separate study of 35 NFL players confirmed the high return rate (83%) but showed that players started fewer games in subsequent seasons.

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SUTURE BUTTON FIXATION SHOWS PROMISING EARLY RESULTS.

The 2024 consensus systematic review (406 athletes) found that suture button fixation for unstable ligament injuries produced higher functional scores, lower complication rates, zero failures, and no secondary procedures compared to traditional screw fixation. However, long-term comparative data are still limited.

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OVER 90% OF ATHLETES RETURN TO SPORT.

A meta-analysis found that 93% to 94% of athletes return to some level of sport after treatment, and 74% to 88% return to their pre-injury level. Return-to-sport timelines range from 6 weeks (stable injuries) to 11 months (NFL players with surgical treatment).

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POST-TRAUMATIC ARTHRITIS IS THE MOST COMMON LONG-TERM COMPLICATION.

Long-term studies show radiographic arthritis in up to 72% of surgically treated patients, with symptomatic arthritis in about 54%. The strongest risk factor is nonanatomic reduction — reinforcing the importance of getting the initial surgery right.

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PATIENT GUIDE

Conclusion

Lisfranc injuries are one of the most consequential — and most commonly missed — injuries in sports. They affect the critical junction between the midfoot and forefoot, and when they're missed or undertreated, the results can be career-altering.

The good news: with accurate diagnosis, appropriate treatment, and structured rehabilitation, over 90% of athletes return to sport. The 2024 International Foot and Ankle Sports Consensus has given us the best evidence-based framework we've ever had for managing these injuries.

The most important message: if you have persistent midfoot pain after a foot injury — especially if you have bruising on the bottom of your foot, pain with push-off, or difficulty bearing weight — do not accept a diagnosis of "midfoot sprain" without advanced imaging. A missed Lisfranc injury can have lifelong consequences. An accurately diagnosed and properly treated one usually doesn't.

If you think you may have a Lisfranc injury, or if you've been told you have a "midfoot sprain" that isn't getting better, seek evaluation by a fellowship-trained foot and ankle surgeon who has experience managing these injuries in athletes.

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ABOUT THE AUTHOR

Dr. Sarang Desai

Dr. Sarang Desai is a fellowship-trained orthopedic surgeon specializing in foot and ankle surgery and sports medicine, based in the Dallas–Fort Worth area. A former All-American athlete at the University of Texas, Dr. Desai brings a unique understanding of what it takes to recover from injury and return to peak performance.

Dr. Desai has served as a professional sports team physician and currently owns multiple professional sports teams, giving him a distinctive perspective on athlete care and return-to-play decisions that few surgeons can offer. He is the inventor of multiple orthopedic implants and surgical devices and has authored numerous peer-reviewed scientific publications.

With more than 15 years of clinical experience, Dr. Desai treats everyone from weekend warriors and recreational athletes to collegiate and professional competitors. His practice is built on evidence-based, personalized care — combining the latest research with real-world clinical expertise to help every patient achieve the best possible outcome.

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References

1. Lisfranc Injuries. Robin R. Elliot, Nicholas B. Jorgensen, Terrence S. Saxby. Chapter 107.