The midfoot injury that can pass for a simple sprain
What a foot and ankle surgeon wants you to know about Lisfranc injuries
A midfoot injury can be missed when it looks like an ordinary sprain. The Lisfranc joints link the middle of your foot to the long bones that run out to your toes. A hard crash can tear the ligaments that hold them together, break bones or do both. The middle of the foot may swell and hurt. Bruising on the bottom of the foot is an important clue. Getting the alignment right matters because your midfoot carries weight each time you take a step. [1]
Find out if the joints are stable
Tell your doctor if it hurts to stand or if the middle of your foot is swollen or bruised underneath. Ask whether your X rays show the joints in line. Sometimes images taken while you stand can reveal a joint that shifts. Your team has to say it’s safe to bear weight first. A CT scan or MRI may give more detail. Don’t push yourself to stand for a scan unless your doctor tells you to. [1]
Stick with the treatment and walking limits
A stable injury may be treated in a cast or boot with limits on putting weight on the foot. An injury that has shifted or is unstable often needs surgery. Ask which plan fits your injury and when your next images are due. A therapist can help you use crutches, a walker or another aid. Feeling less pain on its own doesn’t show the joints are ready for your full weight. [1]
Ongoing or worsening pain needs another look
Call the foot team if pain and swelling don’t go away or your arch changes shape. Also call if walking is still hard after the planned healing time. Get urgent care for a cold or pale foot, new marked numbness or severe pain that keeps getting worse. Follow up visits help catch a joint that has slipped out of place. [1]
Questions about your midfoot
- Are my Lisfranc joints stable and lined up?
- How much weight can I put on this foot?
- Which image will show the joints haven’t moved?
Don't walk off lingering midfoot pain
Your first X ray may look normal. If the pain in your midfoot hangs on anyway, get the follow up your team recommended instead of walking through it. [1]
Sources and further reading
Read this as general education from a foot and ankle surgery perspective. A Lisfranc injury may affect ligaments, bones or both. Walking on an unstable midfoot may push the joints further out of place.
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