Skip to main content

Lisfranc Injuries

  • Chapter
  • First Online:
Orthopedic Surgery Clerkship


The Lisfranc joint complex, consisting of the tarsometatarsal (TMT) articulations, is prone to injury with ligamentous and/or osseous disruption. The Lisfranc ligament, a strong interosseous ligament between the medial cuneiform and second metatarsal provides critical stability for the midfoot arch and allows for forefoot motion. Frequently observed after direct trauma to the foot or a low-energy twisting mechanism through a plantar-flexed forefoot, injuries may range from Lisfranc ligament sprain to fracture dislocations through all TMT joints. Patients often present with severe pain and inability to bear weight after precipitating trauma. Radiographic studies will reveal gapping between the first and second metatarsals at the TMT joint or a “fleck sign.” Treatment is based on stability of the midfoot. Totally stable patients or poor surgical candidates may be immobilized for 6–8 weeks. Unstable Lisfranc injuries necessitate surgery, with rigid screw fixation for the 1–3 TMT joints and Kirschner wires accepted for the fourth and fifth TMT joints. Primary arthrodesis of 1–3 TMT joints is an alternative option for isolated ligamentous injury.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

Similar content being viewed by others


  1. Thompson MC, Mormino MA. Injury to the tarsometatarsal joint complex. J Am Acad Orthop Surg. 2003;11(4):260–7.

    Article  PubMed  Google Scholar 

  2. Scolaro J, Ahn J, Mehta S. In brief: Lisfranc fracture dislocations. Clin Orthop Relat Res. 2011;469(7):2078–80. doi:10.1007/s11999-010-1586-z.

    Article  PubMed  Google Scholar 

  3. Glenn R, Cronin R, Hauzenblas J, Juliano P. Plantar ecchymosis sign: a clinical aid to diagnosis of occult Lisfranc tarsometatarsal injuries. J Orthop Trauma. 1996;10(2):119–22.

    Article  Google Scholar 

  4. Siddiqui NA, Galizia MS, Almusa E, Omar IM. Evaluation of the tarsometatarsal joint using conventional radiography, CT, and MR imaging. Radiographics. 2014;34(2):514–31. doi:10.1148/rg.342125215.

    Article  PubMed  Google Scholar 

  5. Watson TS, Shurnas PS, Denker J. Treatment of Lisfranc joint injury: current concepts. J Am Acad Orthop Surg. 2010;18(12):718–28.

    Article  PubMed  Google Scholar 

  6. Kuo R, Tejwani N, DiGiovanni C, et al. Outcome after open reduction and internal fixation of Lisfranc joint injuries. J Bone Joint Surg Am. 2000;82​(11):1609–18.

    Article  PubMed  Google Scholar 

  7. Ly TV, Coetzee JC. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. Surgical technique. J Bone Joint Surg Am. 2007;89 Suppl 2:122–7. doi:10.2106/JBJS.F.01004.

    Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Amiethab A. Aiyer .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

An, T.W., Kish, A., Varacallo, M., Aiyer, A.A., Vulcano, E. (2017). Lisfranc Injuries. In: Eltorai, A., Eberson, C., Daniels, A. (eds) Orthopedic Surgery Clerkship. Springer, Cham.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-52565-5

  • Online ISBN: 978-3-319-52567-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics