Lisfranc Injury: Understanding and Rehabbing This Midfoot Problem
When you think of serious foot injuries, ankle sprains or fractures usually come to mind. But one of the most important — and often under-recognised — injuries is a Lisfranc injury. This type of midfoot injury can be painful, slow to heal, and if not managed properly, may lead to long-term problems like arthritis or chronic instability.
First a history lesson on Lisfranc injuries…be glad this is the 1800’s !
The Lisfranc injury is named after Jacques Lisfranc de St. Martin, a French surgeon who served in Napoleon’s army in the early 1800s.
During the war, Lisfranc described amputations performed through the midfoot joint complex (what we now call the tarsometatarsal joint) in cavalry soldiers who had fallen from their horses and sustained severe foot injuries. Over time, his name became associated not just with the surgical amputation technique, but with injuries involving that joint and its supporting ligaments.
In this blog, we’ll break down what a Lisfranc injury is, why rehab is so important, and outline a staged 12-week rehab approach based on physiotherapy principles.
What is the Lisfranc joint ?
The Lisfranc joint complex sits in the middle of the foot, where the long metatarsal bones meet the smaller tarsal bones. Its main role is to act as a strong, stable link between the forefoot and midfoot. The ligaments here, especially the Lisfranc ligament, stabilise the arch and prevent the foot from collapsing under load.
During walking, this joint locks the midfoot so the arch can act like a rigid lever for push-off, while also allowing enough flexibility to
absorb shock when the heel strikes the ground. In running and sport, the Lisfranc joint handles even greater forces during sprinting, pivoting, and jumping. It provides both stability for explosive movements and adaptability for rapid changes in direction.
What is a Lisfranc Injury?
The Lisfranc joint complex sits in the middle of your foot, linking the long bones (metatarsals) to the small tarsal bones. These joints and ligaments help stabilise the arch and allow smooth movement when walking, running, or pushing off your toes.
An injury here can involve ligament sprains, fractures, or even dislocation. They often occur in sports (football, rugby, netball), falls, or when the foot twists awkwardly. Key warning signs include:
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Pain and swelling in the midfoot
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Difficulty or inability to put weight through the foot
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Bruising on the sole of the foot
Why Proper Rehab Matters with Lisfranc injuries
A Lisfranc injury is not just “a bad sprain.” Because the midfoot bears so much load, inadequate management can lead to long-term disability. Depending on severity, treatment may involve surgery or immobilisation in a boot or cast.
Once the initial healing phase is complete, structured rehabilitation is essential to restore strength, balance, and function, and to reduce the risk of re-injury.
Lisfranc 12-Week Staged Rehab Plan
The following is a general guide only. The exact timeline varies depending on the severity of injury and whether surgery was needed. Always follow advice from your physiotherapist and treating doctor.
Weeks 1–2: Protection and Pain Management
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Goals: Protect healing tissues, reduce swelling, manage pain.
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Boot or cast for immobilisation.
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Non-weight bearing with crutches.
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Elevation, ice, and compression as advised.
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Gentle movement exercises for the knee and hip to maintain mobility.
Weeks 3–4: Controlled Weight Bearing
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Goals: Gradually reintroduce load through the foot.
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Begin partial weight bearing in a boot (if cleared).
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Gentle range-of-motion exercises for the ankle and toes.
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Isometric strengthening (pressing foot lightly into the floor without movement).
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Core and hip strengthening exercises (bridges, clams, gentle planks).
Weeks 5–6: Mobility and Early Strength
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Goals: Restore movement and begin rebuilding strength.
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Progress to full weight bearing in boot or supportive shoe.
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Foot intrinsic strengthening (towel scrunches, marble pickups).
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Calf raises (double leg).
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Gentle balance work (standing with support, shifting weight side to side).
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Stationary cycling or pool walking for low-impact cardio.
Weeks 7–8: Strength and Balance Progression
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Goals: Improve stability, balance, and strength.
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Transition out of the boot into supportive trainers (if cleared).
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Single-leg balance and wobble board drills.
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Progress calf raises to single leg.
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Theraband ankle strengthening in all directions.
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Walking program on flat ground.
Weeks 9–10: Functional Loading
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Goals: Prepare the foot for everyday and recreational activities.
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Walking longer distances, including uneven ground.
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Step-ups, mini-squats, and lunges.
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Agility ladder or gentle side-steps.
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Light resistance training for lower limb (leg press, hamstring curls).
Weeks 11–12: Return to Activity
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Goals: Restore full function and sport-specific capacity.
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Jogging progression if pain-free.
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Cutting, pivoting, and hopping drills for athletes.
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Hiking, stair climbing, or recreational walking for non-athletes.
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Ongoing strengthening of calf, ankle, and foot muscles.
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Footwear or orthotics advice to support long-term foot health.
Key Takeaway for Lisfranc injury management
A Lisfranc injury can sideline you for weeks or even months, but with the right care and a staged rehab plan, most people can return to normal activities — and even sport. The golden rules are: don’t rush weight bearing, rebuild strength gradually, and retrain balance and function.
If you’ve had a Lisfranc injury, working with a physiotherapist is the safest way to guide your recovery and reduce the risk of future problems.