What is the Lisfranc ligament? Anatomy, function, and injury explained

October 2, 2025 •

3 min read

Affecting approximately 1 in 55,000 people annually, injuries to this specific part of the foot are often misunderstood. The central role of the Lisfranc ligament in maintaining the stability of the midfoot is critical for proper walking and balance.

Quick Summary

The Lisfranc ligament is a complex of tough tissues that connects the medial cuneiform bone to the base of the second metatarsal bone in the midfoot, providing essential stability to the tarsometatarsal joint complex.

Key Points

Anatomical Location: The Lisfranc ligament is a complex band of tissue in the midfoot, connecting the medial cuneiform bone to the base of the second metatarsal. For more information, see {Link: Radiology Reference Article https://radiopaedia.org/articles/lisfranc-ligament}.
Crucial Function: Its primary role is to stabilize the midfoot joint complex and support the foot's arch, which is essential for walking and bearing weight. For more information, see {Link: Radiology Reference Article https://radiopaedia.org/articles/lisfranc-ligament}.
Types of Injuries: Lisfranc injuries can range from sprains and fractures to complete dislocations, with severity depending on the trauma involved. For more information, see {Link: Radiology Reference Article https://radiopaedia.org/articles/lisfranc-ligament}.
High-Energy vs. Low-Energy: Injuries can result from severe trauma like car accidents or simple, low-energy events like twisting the foot during a fall. For more information, see {Link: Radiology Reference Article https://radiopaedia.org/articles/lisfranc-ligament}.
Misdiagnosis Risk: This injury is often mistaken for a simple foot sprain, highlighting the importance of thorough examination and imaging, including weight-bearing X-rays. For more information, see {Link: Radiology Reference Article https://radiopaedia.org/articles/lisfranc-ligament}.
Surgical Intervention: Unstable Lisfranc injuries, fractures, and dislocations typically require surgery to realign and fixate the bones. For more information, see {Link: Radiology Reference Article https://radiopaedia.org/articles/lisfranc-ligament}.
Long-term Consequences: If left untreated, a Lisfranc injury can lead to long-term pain, chronic instability, and debilitating arthritis in the midfoot. For more information, see {Link: Radiology Reference Article https://radiopaedia.org/articles/lisfranc-ligament}.

Anatomy of the Lisfranc Joint Complex

Named after surgeon Jacques Lisfranc de Saint-Martin, the Lisfranc ligament is vital to the midfoot's structure, specifically within the Lisfranc joint complex where tarsal and metatarsal bones meet. For more detailed information on the anatomy of the Lisfranc ligament, please refer to {Link: Radiopaedia https://radiopaedia.org/articles/lisfranc-ligament}.

The Critical Function of the Lisfranc Ligament

This ligament primarily stabilizes the midfoot at the tarsometatarsal joints, forming a stable axis for the foot. Its functions include maintaining the transverse arch, absorbing shock during weight-bearing, transferring force through the foot, and uniquely bridging the gap between the first and second metatarsal bases where no other transverse ligament exists.

Understanding Lisfranc Injuries

Damage to the Lisfranc joint complex is a serious injury, not just a sprain. It can range from minor ligament damage to severe fracture-dislocation.

Types of Lisfranc Injuries

Sprains: Stretching or partial tearing of ligaments.
Fractures: Breaks in midfoot bones, potentially including avulsion fractures.
Dislocations: Bones forced out of their normal alignment.

Common Mechanisms of Injury

Injuries can be caused by both high and low-energy forces, such as car accidents, falls, or twisting the foot during sports or simple falls. Athletes are particularly vulnerable.

How are Lisfranc injuries diagnosed?

Accurate diagnosis is critical to avoid long-term issues like arthritis, as these injuries are often initially missed.

Physical Examination: Doctors check for swelling, bruising (especially on the arch), tenderness, and pain with specific movements, including standing on tiptoes.
Imaging Studies: Imaging confirms the diagnosis.
- X-rays: Show fractures or misalignments; weight-bearing X-rays are vital for detecting instability.
- CT Scan: Offers detailed bone imaging.
- MRI: Provides detailed views of ligaments and other soft tissues.

Treatment Options for Lisfranc Ligament Injuries

Treatment varies based on injury severity and joint stability.

Non-surgical Treatment: For stable sprains, this includes immobilization with a non-weight-bearing cast or boot, RICE (Rest, Ice, Compression, Elevation), and physical therapy for recovery.
Surgical Treatment: Necessary for unstable injuries, fractures, and complete tears.
- Internal Fixation: Bones are realigned and secured with plates or screws, which may be removed later.
- Fusion: In severe cases, bones are fused for stability, limiting movement.

Comparison: Simple Foot Sprain vs. Lisfranc Injury


Feature	Simple Foot Sprain	Lisfranc Injury
Cause	Minor trauma, twisting, or roll of the ankle/foot.	Twisting falls, sports impact, high-energy trauma, heavy object dropped on foot.
Location	Typically affects ligaments around the ankle or a specific bone.	Affects the midfoot, specifically the Lisfranc joint complex.
Severity	Usually less severe, with a shorter recovery time.	Can be severe, potentially involving fractures and dislocations; recovery is often lengthy.
Symptoms	Pain, swelling, and bruising, often localized.	Significant midfoot pain, swelling, bruising on the bottom of the foot, difficulty bearing weight.
Treatment	RICE, immobilization with a brace, gradual weight-bearing.	Strict non-weight-bearing immobilization, and often requires surgery for instability.
Diagnosis	Often diagnosed with physical exam and X-ray.	Requires careful physical exam, weight-bearing X-rays, CT scans, and sometimes MRI to detect subtle instability.

Conclusion

The Lisfranc ligament is a critical midfoot stabilizer essential for normal walking and weight-bearing. Prompt and accurate diagnosis is crucial due to the potential for long-term disability. Seek immediate medical attention for significant midfoot pain, especially with arch bruising or inability to bear weight. Early treatment, whether non-surgical or surgical, is key to preventing complications and achieving the best recovery. For further medical details, consult resources like the {Link: National Center for Biotechnology Information https://www.ncbi.nlm.nih.gov/books/NBK448147/}.

Frequently Asked Questions

The primary function is to stabilize the midfoot, connecting the medial cuneiform to the second metatarsal bone to support the foot's arch during weight-bearing activities like walking and running.

The Lisfranc ligament is located in the midfoot, at the junction between the tarsal bones and the metatarsal bones. It connects the medial cuneiform bone to the base of the second metatarsal.

Common causes include high-impact trauma like car accidents, sports injuries involving twisting or tackles, and low-impact incidents like twisting your foot when falling or missing a step.

Symptoms often include painful swelling on the top of the foot, bruising (particularly on the bottom arch of the foot), significant pain with weight-bearing, and difficulty walking.

It is often misdiagnosed because initial symptoms can seem similar to a regular sprain, especially if no bones are visibly fractured on standard X-rays. Unlike a typical ankle sprain, it is a much more severe and complex injury.

Diagnosis involves a physical exam, which may include stress tests on the foot, and advanced imaging. Weight-bearing X-rays are crucial, along with CT or MRI scans for a detailed look at bone alignment and soft tissue damage.

If left untreated, a Lisfranc injury can lead to long-term instability of the midfoot, chronic pain, and the early development of arthritis, which can significantly impair mobility.