Stable injuries: nonoperative management with close follow-up
Unstable injuries: surgical stabilization to restore anatomy
Anatomic reduction is the most important determinant of long-term outcome
Timing of surgery
Ideally within 1 to 2 weeks
Allow soft tissue swelling to resolve before definitive fixation
Emergent surgery for compartment syndrome or vascular compromise
ORIF versus primary arthrodesis controversy
ORIF traditionally preferred to preserve joint motion
Primary arthrodesis may reduce post-traumatic arthritis and reoperation rates
No high-quality randomized controlled trial definitively favors one approach
Systematic review and meta-analysis (O'Connor 2024) supports both as acceptable
Suture button fixation evidence
Minimum 5-year follow-up data showing satisfactory outcomes
Avoids hardware removal in many patients
Risk factor modification
Smoking cessation
Tobacco use is independent risk factor for post-traumatic arthritis
Counsel all patients on cessation before and after surgery
Glycemic control in diabetic patients
HbA1c below 8% preferred before operative intervention
Neuropathy may mask pain and delay presentation
Weight management
Obesity associated with higher surgical complication rates
Increased midfoot stress with obesity
Patient Discharge Instructions
copy discharge instructions
Lisfranc injury home care instructions
Non-weight-bearing on the injured foot
Do not put any weight through the foot until seen by orthopedics
Use crutches or a walker at all times when moving
Do not attempt to walk on the injured foot even for short distances
Splint care
Keep the splint dry at all times
Cover with a plastic bag when showering
Do not remove the splint
Return immediately if the splint becomes wet, cracked, or causes increased pain
Ice and elevation
Keep the foot elevated above heart level as much as possible
Ice the foot through the splint for 15 to 20 minutes several times daily
Elevation reduces swelling and pain significantly
Pain medications
Acetaminophen every 6 hours as directed
Ibuprofen with food every 6 to 8 hours if no contraindications
Take opioids only as prescribed and only if needed
Do not drive while taking opioid pain medication
Warning signs to return to ER immediately
Increasing pain despite medications
This may be a sign of a serious complication called compartment syndrome
Do not wait until morning if pain is worsening rapidly
Numbness, tingling, or coldness in the toes
Toes turning blue, white, or significantly pale
Toes becoming cold compared to other toes or the other foot
Splint feels too tight or is cutting into the skin
Fever above 38.5 degrees Celsius
Wound drainage or signs of infection if you have an open injury
Follow-up instructions
Orthopedic surgery appointment within 5 to 7 days
Bring this discharge paperwork to the appointment
Repeat X-rays will be taken at that visit
The orthopedic surgeon will determine if surgery is needed
Do not miss this appointment
Lisfranc injuries can worsen without proper follow-up
A missed appointment could result in a stable injury becoming unstable
Recovery expectations
Non-weight-bearing for a minimum of 6 weeks for most injuries
Full recovery typically 4 to 6 months for non-surgical injuries
Surgical cases may take 6 to 12 months or longer
Some degree of chronic midfoot stiffness or pain may persist even with optimal treatment
Post-traumatic arthritis is a known long-term complication
References
Guidelines and key sources
Key clinical references
McDermott A et al. High Risk and Low Incidence Diseases: Lisfranc Injury. American Journal of Emergency Medicine. 2024. PMID 39276688
Lau S et al. Lisfranc Fracture Dislocation: A Review of a Commonly Missed Injury of the Midfoot. Emergency Medicine Journal. 2017. PMID 27013521
Poutoglidou F et al. Acute Lisfranc Injury Management. The Bone and Joint Journal. 2024. PMID 39615511
Ahluwalia R et al. Surgical Controversies and Current Concepts in Lisfranc Injuries. British Medical Bulletin. 2022. PMID 36151742
Juto H et al. Epidemiology Classification and Treatment of 2084 Lisfranc Injuries: An Observational Study from the Swedish Fracture Register. Injury. 2025. PMID 39626601
Imaging and diagnostic guidelines
Expert Panel on Musculoskeletal Imaging et al. ACR Appropriateness Criteria Acute Trauma to the Foot. JACR. 2020
Sripanich Y et al. Imaging in Lisfranc Injury: A Systematic Literature Review. Skeletal Radiology. 2020. PMID 31368007
Kennelly H et al. Utility of Weight-Bearing Radiographs Compared to CT for Diagnosis of Subtle Lisfranc Injuries in the Emergency Setting. Emergency Medicine Australasia. 2019. PMID 30780193
Tamir E et al. Lisfranc Injury Diagnosis: Diagnostic Reliability of New Radiographic Signs Using 3D CT. Clinical Orthopaedics and Related Research. 2023. PMID 37078895
Surgical outcome references
O'Connor KP et al. Primary Arthrodesis Versus ORIF for Acute Lisfranc Injuries: A Systematic Review and Meta-Analysis. Archives of Orthopaedic and Trauma Surgery. 2024. PMID 39680239
Dubois-Ferriere V et al. Clinical Outcomes and Development of Symptomatic Osteoarthritis 2 to 24 Years After Surgical Treatment of Tarsometatarsal Joint Complex Injuries. JBJS. 2016. PMID 27147683
Sinkler MA et al. Complications and Outcomes After Fixation of Lisfranc Injuries at an Urban Level 1 Trauma Center. Journal of Orthopaedic Trauma. 2024. PMID 38294227
Saito GH et al. Results of Lisfranc Injuries Treated With Interosseous Suture Button Fixation With Minimum 5-Year Follow-Up. Foot and Ankle International. 2025. PMID 40077945
Pain management guidelines
Qaseem A et al. Nonpharmacologic and Pharmacologic Management of Acute Pain From Non-Low Back Musculoskeletal Injuries in Adults. Annals of Internal Medicine. 2020
Hsu JR et al. Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury. Journal of Orthopaedic Trauma. 2019. PMID 30681429
ICD-10 coding references
ICD-10 S93.325A dislocation of tarsometatarsal joint of right foot initial encounter
ICD-10 S93.326A dislocation of tarsometatarsal joint of left foot initial encounter
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.