You came down awkwardly (off a kerb, out of a tackle, down a step) and your foot twisted underneath you while it was pointed. Or something heavy landed on it. The top of your foot swelled, standing on it hurts, and someone has said it's probably just a sprain. That's the assumption worth checking. A Lisfranc injury is an injury to the midfoot, and it's sometimes mistaken for a sprain 3, which matters, because the two are managed very differently.
The Lisfranc joint is the line where the long bones of your forefoot meet the smaller bones of your midfoot, held together by strong ligaments. It's injured when that line is forced apart, typically after you've fallen and twisted your foot, crushed it while it was flexed, or landed from a height 3.
What follows is fairly consistent: swelling and tenderness over the midfoot or top of the foot, pain that's worse walking or standing, and bruising on the top or the underside of the foot 3. Bruising on the sole is particularly telling 1, as is midfoot pain going down stairs 1. In athletes it often shows up as lasting pain on walking and difficulty with push-off 4.
A ligament-only injury can look fairly minor at first even when it's significant 4: "it doesn't look that bad" isn't reassurance. And the hands-on tests only raise suspicion: working out how stable the joint is takes weight-bearing x-rays and scans 4, which is why imaging matters more here than the hands-on examination.
A Lisfranc injury is midfoot and top-of-foot pain that started with a specific event: a fall, a twist, a crush, a landing 3, with tenderness along the joint line where the toe bones meet the midfoot, and difficulty putting weight through it 4. Plantar fasciitis is a heel problem that comes on gradually, with no injury behind it. If that second description is closer to yours, start from the Foot section of our Injury Finder instead.
The mimics that do sit close to a Lisfranc injury are other midfoot problems: a midfoot sprain, a fracture of the navicular, the cuboid or another small midfoot bone, and a fracture at the base of the fifth metatarsal 4. Telling those apart is an imaging question, not a self-assessment one.
A Lisfranc injury is easy to miss, so the diagnosis starts with suspicion: how you were hurt, and where the foot is sore. We press along the top of the midfoot. Then we may move the long bones of the forefoot up and down (the piano-key test), squeeze across the width of the foot, or turn the forefoot outwards while holding the heel still. Pain or a click points towards the joint 1.
Those tests only raise suspicion. Imaging decides the rest. If standing is too painful at first, the standing X-ray can wait a week 1. Up to 20 per cent of cases are missed on the first X-rays, so if suspicion stays high a CT scan is next, and an MRI can show the ligament itself 1.
Before anything else: this decision isn't ours alone, and it isn't made on how the foot feels. Where there's a proven Lisfranc injury or a high degree of clinical suspicion, the referral is to an orthopaedic team, and you stay off the foot until that review 1.
A note on the evidence. There are no randomised controlled trials comparing non-operative with surgical treatment here; the conservative results come from a few retrospective case series without broad agreement on the indications 2. That's standard practice, not proven-superior practice, which is why the imaging gate above does the real work.
The two published protocols differ. One describes a walker boot with protected weight bearing from around two weeks 1; the other, six weeks non-weight-bearing in a short leg cast, then gradual return with an insole that offloads the arch 2. Which applies to you is your treating team's call. Follow theirs, not a timeline you read.
Weeks in a boot leave a foot and ankle stiff, and hands-on work is one way we address that alongside your loading program. None of the research cited here singles out manual therapy as the active ingredient for a Lisfranc injury. Treat it as an adjunct, not the main event.
Being immobilised carries a real risk of a blood clot, and blood thinners are commonly used through the first six weeks; boots and casts can also cause pressure sores 3. Both are conversations with your treating doctor, not something we prescribe or manage.
With a Lisfranc injury, The Well Motion Recovery Path™ runs inside the limits your orthopaedic team sets. You move up a phase on what the foot and its x-rays show, not on a date.
How long it usually takes. Normally over 12 weeks to heal, with pain and swelling likely beyond 12 months 3. Sport takes longer. Of 17 professional soccer and rugby players treated surgically, 16 returned to full competition at a mean of 25.3 weeks 7. Of 28 NFL players, 26 returned at a median of 11.1 months 8. Both are small groups of elite athletes. Your surgeon sets your timeline.
No study has tested how to prevent a second Lisfranc injury. What exists is the recovery protocols, and they're specific:
Get this assessed rather than managing it yourself if:
And the instruction that overrides everything else here: do not put weight through the injured foot until a foot and ankle team has told you it's safe to 3, and stay non-weight-bearing until your orthopaedic review 1.
The reassuring part is that this is solvable once it's identified. The bad outcomes in the literature cluster around injuries that were missed or inadequately stabilised, not around injuries found early and managed properly.
We start by listening: how it began, what makes it worse, and what it's stopping you from doing. Then we examine the area, explain what we find in plain English, and agree a plan with you. Your first visit is 40 minutes at Engadine and 30 minutes at our other clinics.
We see patients at Engadine, Mount Annan, Narellan and Appin, and at home through our mobile physiotherapy service. If you have private health cover, here's how health fund rebates work for physiotherapy.
Normally over 12 weeks, and residual pain and swelling for over 12 months is likely 3. Returning to competitive sport, expect at least 6 to 12 months 1.
Not until you've been cleared. Do not put weight through the injured foot until a member of the foot and ankle team tells you to 3, and stay non-weight-bearing until your orthopaedic review 1. Difficulty weight bearing is one of the typical presenting signs in the first place 4.
Yes, and we'd rather say so than soften it. It's described as a significant, life-changing injury that may lead to lifelong challenges, difficulty doing your current job and, rarely, amputation 3. It's a red flag condition in general practice 1, and post-traumatic arthritis develops in roughly 40 to 94% of patients even after surgical fixation 1,2.
Sometimes, within a narrow indication: stable, non-displaced injuries with pure ligament sprains, six weeks non-weight-bearing, then a gradual return using an arch-support insole 2. Two caveats belong with that: the supporting evidence is a few retrospective case series, not randomised trials 2, and purely ligamentous injuries often carry a poor prognosis 1. There are real positive results too: one case series reported nine athletes back to competition at an average of four months, and a series of 55 people with non-displaced injuries reported good pain and function at two to six years 2.
There isn't a single best treatment. There's a decision based on stability. No instability or widening on a weight-bearing x-ray means non-operative management is appropriate; any instability or clear widening requires surgery 1, and there's strong consensus that high-energy trauma with displaced or unstable injuries needs operating on 2. No trial has compared the two head to head 2.
Inadequately stabilised injuries carry a high risk of debilitating post-traumatic degenerative change. Post-traumatic arthritis is described as a potentially devastating but common complication of poorly treated or missed Lisfranc injuries, often ending in a midfoot fusion, with chronic pain and lost working productivity alongside it 1.
After the boot phase, a stiff-soled shoe with rigid orthotic support for the next six months 1, or an insole that offloads the arch as you return to activity 2. While you're still in the boot, a supportive firm-soled shoe matching the boot's height on your uninjured side reduces the stress that height difference puts through your other joints 3.
Sharp heel pain that's at its worst on your first few steps out of bed, settles once you get moving, then comes back after sitting or a long day on your feet.
Read moreHeel pain in an active, growing child, usually somewhere between 8 and 14, turning up after footy or athletics training.
Read moreIt's a thickening of the tissue around one of the nerves between your toes, after that nerve has been irritated or damaged.
Read moreTurf toe is the sporting name for a sprain of the big toe joint: the structures underneath get overstretched or torn when the toe is forced upwards.
Read moreMetatarsalgia is a general term for pain around the joints at the base of your toes, a group of conditions rather than a single one. Which one you have changes what helps.
Read moreA stress fracture is a fine crack in a bone from repeated loading without enough recovery between efforts, not a one-off injury. In the foot and lower leg it's the most common form of hairline fracture, usually from jogging or running.
Read moreCuboid syndrome is pain on the outer midfoot, thought to come from a subtle disruption of the joint between the cuboid (a small bone on the outside of your foot) and your heel bone. The exact mechanism hasn't been worked out.
Read moreTarsal tunnel syndrome is compression of the tibial nerve as it runs behind your inner ankle, under a band of tissue called the flexor retinaculum.
Read moreA heel spur (calcaneal spur) is a small outgrowth of bone on the heel bone. It can form on the underside or at the back.
Read moreA bunion (hallux valgus) is a bony lump at the big toe joint that forms when the big toe leans towards the other toes. Around 23% of adults have one.
Read more
How would you like to reach us?
Message us on WhatsAppFor bookings and enquiries. Please don't send medical details. Call (02) 8111 5633Request a call-back
Request sent
Thank you. We'll call you back on the number you gave us.
This is a preview, so nothing was actually sent.