General information only, and not a substitute for medical advice. If your foot is
deformed, you cannot put weight through it, or the foot is numb or cold, seek urgent
assessment.
There is one sign in foot injuries that changes the whole picture: bruising on
the sole of the foot. It looks unremarkable, patients rarely mention it, and it
is one of the more reliable indicators of a Lisfranc injury — an injury that is commonly
mistaken for a sprain and does badly when it is missed.
A painful foot after a twist, a fall or a tackle is usually called a sprain, and often
that is what it is. But some of these injuries involve the Lisfranc joint complex, where
the long bones of the foot meet the midfoot, and those need identifying early.
Worried about a midfoot injury?
Book an assessment online or call
1300 525 666 — Southport and Springwood, no referral needed.
What a Lisfranc injury actually is
Damage to the ligaments or bones in the midfoot that hold the arch together. It comes
in three forms:
- A midfoot sprain — ligament injury alone
- A midfoot fracture — a broken bone
- A fracture-dislocation — both, and the most serious
The mechanism does not have to be dramatic. Missing a step, twisting while running, or
landing awkwardly can all cause significant damage. Football, netball, rugby and basketball
account for many of them; so do falls from very modest heights.
Signs that should raise concern
Most midfoot injuries swell and bruise. These features specifically point towards a
Lisfranc injury:
- Bruising on the sole of the foot. The classic red flag, and worth
looking for deliberately. - Pain through the middle of the foot, worse on standing or walking
- Difficulty or inability to weight-bear
- Swelling across the top of the foot
- Pain when pushing up onto the toes
- A sense that the foot is unstable
Any of these after a twist or fall is worth same-day or next-day assessment.
Why these injuries get missed
Two reasons. First, people can often still walk on a Lisfranc injury, particularly
early, so it gets dismissed as a sprain. Second, and more importantly: a
non-weight-bearing X-ray can look normal even when the injury is significant. The
midfoot only reveals its instability under load.
So depending on the examination, a clinician may arrange weight-bearing X-rays if you
can tolerate them, a CT for small fractures, or an MRI to assess the ligaments.
This is why the examination matters as much as the image, and why a normal first X-ray
does not close the question if the clinical picture is concerning.
Bruising on the sole, or pain in the middle of the foot after a twist? Get it imaged.
Book online or call
1300 525 666.
The first 48 hours
- Stop sport, and avoid walking on it.
- Elevate the foot above heart level where you can.
- Ice for 10 to 15 minutes at a time, with the skin protected.
- Simple pain relief if it is suitable for you.
- A stiff-soled shoe, a boot, or crutches if you have them.
Do not push through the pain. Continuing to weight-bear on an unstable midfoot can worsen
the displacement.
Treatment
Stable injuries, where the joint has not shifted, are usually managed
with a boot or cast, strict limits on weight-bearing at first, and follow-up imaging to
confirm nothing has moved.
Unstable injuries need prompt orthopaedic review and often surgery to
restore and hold the alignment.
The reason for urgency is what happens otherwise. A missed or late-treated Lisfranc
injury carries a real risk of chronic midfoot pain, loss of arch height, and arthritis in
the midfoot joints.
Recovery
Minor sprains often take six to twelve weeks before higher-impact activity is
comfortable. Fractures and unstable injuries commonly take three to six months, sometimes
longer. Both vary considerably with the individual injury.
Seek urgent assessment if
- The foot looks deformed
- Swelling is severe or pain is escalating
- There is numbness, colour change, or the foot feels cold
- You cannot weight-bear
- There is bruising on the sole
- The pain seems out of proportion to a sprain
Frequently asked questions
Can a Lisfranc injury heal without surgery?
Stable injuries often can, with immobilisation and careful follow-up. Unstable ones
usually need surgical stabilisation to restore alignment.
If I can walk on it, is it just a sprain?
Not necessarily. Many people walk on a Lisfranc injury early on. Persistent midfoot pain
and swelling after a twist deserves assessment regardless.
Which scan is best?
X-ray is usually first, ideally weight-bearing. CT shows small fractures better; MRI is
better for ligament damage. The examination determines which is appropriate.
How long will I be in a boot?
Often several weeks, depending on stability and pain. Your clinician will advise.
What happens if it is missed?
Chronic pain, a flattened arch and midfoot arthritis are all recognised consequences of
delayed treatment. Early diagnosis materially improves the outcome.
Book an assessment
If you have had a twist or a fall and now have midfoot pain, swelling or difficulty
walking, early assessment is worth it — particularly if there is any bruising on the sole.
Book online or call
1300 525 666. Clinics at
Southport on the Gold Coast and
Springwood in South Brisbane.
Related reading:
Metatarsal fractures ·
Ankle fractures ·
Ankle fracture or sprain