When New York Giants left tackle Andrew Thomas went down with a Lisfranc injury during the 2025 season, requiring surgery that ended his year, it put a spotlight on one of the most misunderstood and frequently misdiagnosed injuries in professional sports. Yet Lisfranc injuries are not exclusive to 300-pound offensive linemen. They happen to runners, hikers, weekend basketball players, and anyone who plants their foot and twists under load. As an orthopedic foot and ankle surgeon, I see the consequences of delayed Lisfranc diagnosis regularly—and the difference between early intervention and a missed diagnosis can be the difference between full recovery and chronic disability.
At the 2026 AAOS Annual Meeting, foot and ankle specialists from around the world convened to discuss the latest approaches to managing these complex injuries in athletes, with a consensus group preparing to address syndesmotic and midfoot injuries at the upcoming ESSKA Congress in Prague. The message from the research community is clear: Lisfranc injuries deserve the same urgent attention we give to ACL tears and Achilles ruptures.
The Science: Why the Lisfranc Joint Is So Vulnerable—and So Often Missed
The Lisfranc joint complex is not a single joint but a series of articulations where the five metatarsal bones meet the midfoot tarsal bones. The Lisfranc ligament itself is a thick band connecting the medial cuneiform to the base of the second metatarsal, the “keystone” of the midfoot arch. This ligament has no redundancy. When it fails, the entire architecture of the midfoot destabilizes.
The injury mechanism is deceptively simple: axial loading on a plantarflexed foot. A football player steps on another player’s foot and stumbles forward. A runner catches the edge of a curb. A dancer lands from a jump with the forefoot planted and the body rotating over it. In each case, the midfoot absorbs forces it was never designed to handle in that position, and the Lisfranc ligament, along with surrounding bones and soft tissue, gives way.
Here is the clinical problem: Lisfranc injuries are misdiagnosed as simple midfoot sprains up to 20% of the time on initial presentation. Standard X-rays taken with the foot non-weight-bearing may appear normal, masking subtle diastasis (widening) between the first and second metatarsals that signals ligament disruption. The patient is told they have a “foot sprain,” sent home in a walking boot, and presents weeks or months later with persistent pain, swelling, and an inability to push off during gait.
Data from the NFL shows that more than 90% of athletes who sustain Lisfranc injuries eventually return to play, but at a median of 11.1 months from injury, and many never return to their pre-injury performance level. The key variable? Accurate early diagnosis and appropriate surgical intervention when indicated. Delayed treatment leads to chronic midfoot arthritis, arch collapse, and long-term disability that may require salvage fusion surgery.
The Solution at P.O.W.: Advanced Imaging and Precision Surgical Repair
At Prisk Orthopaedics and Wellness, we have invested in weight-bearing CT technology specifically because injuries like Lisfranc demand it. A weight-bearing CT scan reveals the three-dimensional relationships among the bones of the midfoot under physiologic load, detecting subtle instability patterns that standard X-rays and even MRI can miss. When a patient presents with midfoot pain after a twisting injury, and the X-rays “look fine,” a weight-bearing CT can be the difference between a correct diagnosis and a missed one.
For stable Lisfranc injuries, those with ligament sprains but no structural displacement, we employ a strict non-weight-bearing protocol with serial imaging to monitor for delayed instability. For unstable injuries with displacement or fracture-dislocation, surgical fixation is required. Our approach favors anatomic reduction with modern fixation constructs that restore precise midfoot alignment, because even 1–2 millimeters of residual displacement has been shown to accelerate post-traumatic arthritis.
Post-surgical rehabilitation follows a structured, evidence-based timeline: six to eight weeks of non-weight-bearing, progressive weight-bearing over the next four to six weeks, and sport-specific reconditioning beginning at three to four months. We monitor recovery with repeat weight-bearing CT to confirm hardware position and joint alignment before clearing patients for return to activity.
If you have been told you have a “midfoot sprain” that is not improving, especially if it happened during a twisting or stumbling mechanism, do not accept that diagnosis at face value. A missed Lisfranc injury becomes exponentially harder to treat with each passing week.
Take the Next Step
Schedule your evaluation at orthoandwellness.com or call our Monroeville office. Dr. Prisk specializes in complex foot and ankle injuries and has the advanced imaging technology to diagnose what others miss. Your midfoot pain deserves answers.
