Written by Zita Sham, Fairuuz Saleh and Shiv Mohan Banka, Principal Physiotherapists at Phoenix Rehab.Clinically reviewed by Louise Yow, Principal Physiotherapist & Director, AHPC A1300363H.Last reviewed 28 September 2026.
Something happened to the middle of your foot. A fall. A tackle. A foot that went one way while the rest of you went the other. It swelled across the top, you strapped it, you rested it, and you told yourself it was a sprain.
Except it has not behaved like a sprain. A week in, maybe two, and you still cannot put proper weight through it. Standing on your toes is out of the question. And when you looked at the sole of your foot in decent light, there was bruising in the arch you could not explain.
Somewhere along the way you found the phrase Lisfranc injury. Either a doctor said it, or the internet did at one in the morning.
Start here, because it matters more than anything else on this page. A suspected Lisfranc injury is a medical assessment, and often a surgical one. It is not something to manage with exercises from a website, ours included. If the pattern below sounds like your foot, the next step is a doctor and the right imaging.
Our physios at Phoenix Rehab work with these injuries constantly, almost always after the surgeon has decided. Rehabilitation here is long and easy to get wrong, and that is where our value sits. But it comes second. Diagnosis comes first.
What a Lisfranc injury actually is
Look at the middle of your foot, roughly where the laces sit. Underneath that skin, the long bones running out to your toes meet a cluster of smaller, chunkier bones that form the arch. That meeting point is the Lisfranc joint, named after a French army surgeon from Napoleon’s era. Not one joint. A row of them, side by side across the foot.
Picture a stone arch on an old bridge. The stones hold each other up because of their shape, and because one wedge shaped stone at the top, the keystone, locks the whole thing. Take the keystone out and the arch does not sag. It collapses.
Your midfoot works the same way. The second long bone of the foot sits recessed between the bones either side of it, slotted in like that keystone. Holding it there is a thick ligament running diagonally underneath the joint, the Lisfranc ligament. A ligament is simply a band of tough tissue tying one bone to another.
When it tears, or when the bones it anchors break, which is what people mean by a Lisfranc fracture, the keystone loses its grip. The bones can shift apart even a small amount, and that small amount is the whole problem. The midfoot is built to be rigid so it can drive your weight forward when you push off. A joint that should not move now moves. Every step loads a structure that no longer locks, and the arch begins to give way.
That is why this behaves so differently from an ankle sprain, which stretches tissue designed to move. A Lisfranc injury undoes a structure designed to hold still.
How it happens
There are two versions, and the second one hides.
The high energy version is obvious to everybody. A motorcycle accident where the foot is crushed or twisted at speed. A fall from a height. A heavy crate landing on the midfoot. These reach the emergency department with an obviously deformed foot and nobody mistakes them for minor.
The low energy version happens in sport and in ordinary life, and looks like nothing much at first.
- A fall with the foot pointed downwards, toes bent under, body weight driving down the length of the foot.
- A twist with the foot planted and the body rotating over it, common when a boot sticks in the turf.
- A misstep off a kerb or a stair, the foot landing half on and half off the edge.
- A player falling across the back of your leg while your foot is pinned under you. The classic rugby and football mechanism.
In Singapore that list looks familiar. Football on artificial pitches where studs grip hard. Rugby rucks. Kerbs and pavement joins a running foot finds at the wrong angle. Stairs taken two at a time. Motorcycle and delivery rider accidents. Warehouse work where something heavy lands on a foot in the wrong place.
Those are exactly the ones that get called midfoot sprains. The foot swells but is not deformed. The person can often limp. In every superficial way it resembles a sprain.
How to tell if this is what you have
None of these signs prove anything alone. Together they form a pattern that deserves a doctor’s eyes quickly.
Bruising on the sole of the foot, in the arch. If there is one sign worth knowing, it is this. Blood from the torn ligament tracks down into the sole, so bruising appears under the arch, often a day or two later, sometimes faint. Take your sock off, sit under a good light, and actually look at the bottom of your foot. A plain midfoot sprain does not usually do this.
Swelling across the top of the midfoot, not around the ankle. An ankle sprain swells around and below the ankle bones. This swells across the band where your shoelaces sit.
You cannot push off or stand on tiptoe. Rising onto the ball of your foot loads the midfoot arch directly. If that is sharply painful or simply not possible, that matters.
Pain when the forefoot is twisted. Holding the heel still and gently rotating the front of the foot reproduces it. So does pressing along that line across the top.
Weight bearing difficulty out of proportion to what happened. The one people talk themselves out of. The injury looked minor, the swelling is unremarkable, but you cannot walk on it. That mismatch is information.
Not settling on a sprain’s timetable. Most sprains are better week on week. One that is much the same at two weeks has earned a second look.
Pain further forward, under the ball of the foot, with no clear injury behind it, is more likely metatarsalgia. Pain closer to the heel is more often heel and arch tissue. The Lisfranc pattern sits in the middle band of the foot and traces back to a specific moment.
Why this injury is genuinely hard to catch
A standard foot x-ray is taken with you lying or sitting, with no weight going through the foot. Without load, the midfoot bones can sit back in near enough their normal positions, and the image can look entirely normal even when the ligament is torn. The gap only opens when the foot is asked to carry you.
That is why weight bearing x-rays matter. Standing on the foot for the image, sometimes comparing both feet side by side, reveals separation that a lying down image completely hides. Where the picture is still unclear, a CT scan shows finer bone detail and an MRI scan shows the ligament itself.
None of this means anyone did anything wrong. A doctor who initially calls a swollen midfoot a sprain is reading exactly what the evidence in front of them shows, and that first x-ray genuinely can be clean. The injury hides. What changes the outcome is going back when the foot is not behaving the way a sprain should.
Get medical assessment promptly if:
- Bruising on the sole of your foot in the arch.
- You cannot bear weight properly, or cannot rise onto your toes.
- The foot looks wider, flatter or different in shape to the other one.
- Numbness, pins and needles, coldness or color change in the foot or toes. Same day attention.
- A midfoot injury no better after about two weeks.
If you have already been told it is a sprain and it is not behaving like one, go back. Ask whether a weight bearing x-ray is appropriate. That is a reasonable question and a good doctor will welcome it.
What happens if it is missed
An unstable midfoot that keeps getting walked on does not stay the same. Bones that should be locked together sit slightly apart, and every step grinds surfaces never meant to move against each other. Over months they wear.
What follows is fairly predictable. Persistent midfoot pain that never fully clears, worse after a day on your feet. Progressive flattening of the arch as the keystone structure gives way, so the foot spreads and drops. A change in shape that shows up in how shoes fit. And in time, midfoot arthritis, meaning wear in those joints, with stiffness and aching most days.
Late reconstruction is a harder problem than early treatment. Once the shape has changed and the joints have worn, surgery becomes less about putting bones back where they belong and more about stiffening a painful, deformed midfoot into a stable position. Bigger operation. Longer recovery. Different ceiling on the result.
That is not written to frighten you. The window where this is a straightforward problem is measured in weeks, and people spend those weeks hoping it settles.
How it gets treated
The surgeon decides this. What follows describes the landscape so you understand the conversation you are about to have. It is not a recommendation.
Non surgical care. A genuinely stable, non displaced injury, meaning the ligament is injured but the bones have not shifted, may be managed without surgery. Usually a rigid boot or cast and restricted weight bearing, then re-imaging to confirm nothing has moved. That is a legitimate path for the right injury, and only when imaging has confirmed stability. Which is precisely why the imaging matters so much.
Surgery. Displaced or unstable injuries are usually treated surgically. The aim is to return the bones to their correct positions and hold them there while everything heals, because the midfoot only works when it is aligned. Broadly, surgeons either fix the joint with screws or plates, or fuse part of the midfoot, meaning those small joints are deliberately joined so they stop moving at all. Which approach suits which injury depends on the damage pattern and the surgeon’s judgement about that foot.
Phoenix does not choose between these and does not second guess them. Our job starts once that decision is made.
Rehabilitation, and why it decides how well you end up
The operation improves the structure. Rehabilitation improves the foot. Two different jobs, and the second takes far longer than people expect.
Every timeline below is a general shape, not your program. Your surgeon sets the weight bearing rules and the milestones. If anything here conflicts with what your surgeon told you, your surgeon is right.
The protected stage. For the first stretch you will be in a cast or boot, off the foot or barely on it. Typically around six to eight weeks, sometimes longer.
The foot is not being trained yet, but this is not dead time. Hip and knee strength on both legs. Toe movement where permitted. Keeping the other leg, the trunk and the upper body conditioned so you are not rebuilding your whole body later. Swelling managed with elevation. And getting competent on crutches, because a fall onto a healing foot is a serious setback.
Coming back onto the foot. When the surgeon clears loading, weight returns gradually, usually in the boot first, as a planned progression rather than one day where you stop using crutches. Partial weight, then more, then walking in the boot, then out of it. The foot will feel stiff and achy and oddly unfamiliar. That is normal.
Movement and calf strength. Two things reliably surprise people. The first is stiffness. Weeks in a boot leave the ankle and midfoot tight, especially pulling the foot upwards towards your shin. Without that movement the body compensates by rolling the foot inwards or turning the leg out, loading everything else badly.
The second is how much the calf shrinks. After two months in a boot the calf on the injured side is visibly smaller. Not slightly. Visibly. That muscle pushes you off the ground, and rebuilding it is slow work measured in months. Moving from double leg heel raises to single leg, then weighted, then fast and springy, is the core of how our physios work with post-surgical recovery.
Balance. An immobilized foot loses its sense of position, so standing on one leg feels unfamiliar. That sense is trainable, and it has to return before running does, because a foot that cannot organize itself turns on the next uneven surface.
Returning to running and sport. Graded, in this order. Walking distance, then varied surfaces, then a walk run progression, then straight line running, then changes of direction, then sport specific work, then contact or competition. Each step is earned by how the foot responds over the next day or two, not by the calendar.
Be prepared for a full return to sport after a surgical Lisfranc injury to take the better part of a year. [Some are quicker. Some longer, particularly after higher energy injuries or where fusion was involved. Walking and work come back much earlier than a pitch does.
Being honest about outcomes
Many people do well after a Lisfranc injury caught promptly, treated appropriately and rehabilitated properly. They walk normally, return to work, get back to what they enjoy.
That is not everyone. Some are left with a midfoot that aches after a long day standing, stiffness that never fully clears, or a foot that will not tolerate certain shoes. Midfoot arthritis stays a real possibility even when everything is done well, because those joint surfaces were injured at the moment of the accident and no operation undoes that. Anyone promising you a consistent result here is not being straight.
Getting assessed at Phoenix Rehab
If you are still in the diagnosis stage, see a doctor first. If you want help working out whether your midfoot injury warrants that visit, message us and we will tell you plainly. We would far rather send you to a doctor than take a booking we should not take.
If you have had surgery or been put in a boot and you want the rehabilitation, the first appointment is a proper conversation before anything else. We want your operation notes or your surgeon’s instructions, your weight bearing status, and your milestones. From there we assess what is available right now. Movement at the ankle and midfoot. Calf size and strength against the other leg. Balance. How you move in the boot.
What our patients say
Google reviews from our clinics in Singapore.
Then you get a plan with stages and rules attached, so you know what you are doing this fortnight and what has to be true before the next stage starts. Find us at our clinic locations in Orchard, Tampines, Serangoon and Tanjong Pagar, with Jurong East opening 25 October 2026. WhatsApp 8336 6009 if you want to talk it through first.
Frequently asked questions
How do I know if my midfoot sprain is actually a Lisfranc injury?
You cannot know for certain without imaging. Some signs raise the suspicion sharply. Bruising on the sole of the foot in the arch. Swelling across the top of the midfoot. Being unable to rise onto your toes. Trouble bearing weight that seems worse than the injury looked. No improvement after two weeks. Any of these means see a doctor.
Can a Lisfranc injury show up as normal on an x-ray?
Yes, and this is the crux of it. An x-ray taken without weight through the foot can look normal even when the ligament is torn, because the bones only separate under load. Weight bearing x-rays, and where needed a CT or MRI scan, reveal it. This is why the injury is hard to catch early.
What are the symptoms of a Lisfranc injury?
Pain across the middle of the foot, swelling on top of the midfoot rather than around the ankle, bruising under the arch, pain when twisting the forefoot, inability to push off or stand on tiptoe, and difficulty bearing weight. The foot may look wider or flatter than the other one.
Does every Lisfranc injury need surgery?
No. A genuinely stable injury where the bones have not shifted may be treated in a boot or cast with restricted weight bearing, then re-imaged to confirm nothing has moved. Displaced or unstable injuries are usually surgical. That decision belongs to the treating surgeon and depends on what the imaging shows.
How long is Lisfranc injury recovery time after surgery?
Expect a long road. A period off the foot, commonly six to eight weeks, then a graded return to weight bearing, then months of rebuilding calf strength, movement and balance. Full return to sport is often the better part of a year. Your surgeon’s protocol sets your timeline, not an article.
What happens if a Lisfranc injury is not treated?
The midfoot stays unstable and the joints wear. Over time that means persistent midfoot pain, flattening of the arch, a change in the shape of the foot, and midfoot arthritis. Reconstruction at that late stage is a bigger operation than early treatment would have been.
Can physiotherapy fix a Lisfranc injury without surgery?
No. Physiotherapy cannot repair a torn ligament or reposition displaced bones. Where a surgeon has confirmed the injury is stable and chosen non surgical management, physiotherapy has an important role in the recovery afterwards. It is never an alternative to getting the injury properly diagnosed.
If your foot is telling you something, listen to it
The reason this matters is not the next few weeks. It is the next thirty years of walking.
A midfoot that heals aligned and strong carries you through long days, holiday walking, carrying your kids, chasing a ball. One that quietly collapses takes that away slowly, one compromise at a time, until you are choosing shoes around your foot and planning your day around how far you will have to walk.
You get one clean shot at treating this properly. If the pattern on this page sounds like your foot, see a doctor this week and ask about weight bearing imaging. If you have already had the operation, WhatsApp 8336 6009 or find us at our clinics and we will build the program around your surgeon’s plan.
Get it looked at. Then get it strong.
Where are you with this right now?
1. It is settling on its own
Foot and ankle problems are slow but usually very treatable. Months rather than weeks is normal, and improvement is judged over a month, not a day. If the first steps in the morning are easier than they were four weeks ago, you are on the right road. You do not need us for this, and we would rather say so.
2. It has stopped improving
The first ten steps out of bed are still the worst part of the day. You choose shoes by how long you will be standing. You still look at the ground when you walk.
Symptoms settle well before the tissue has rebuilt its capacity, which is why stopping the loading work early is the most common reason this drags on for years. That is the gap worth measuring, and it is not measured by how you feel on the day.
The Stalled Recovery Review is three appointments over three weeks with the same therapist, because what a joint does under load cannot be read in one visit. The first finds what is limiting it. The next two measure how it responds. $690, nett, no GST, which is three appointments at $230.
3. You have had surgery, or you have a date
Recovery after an operation has a shape, and knowing which stage you are in tells you whether you are on it. See the recovery programs, or ankle physiotherapy if you are not sure which applies to you.
All of it runs on the same four stages. The Phoenix Recovery Protocol explains what each stage works on and what you have to meet to move up. No referral needed to start.
Next step
Find out which stage you are in
Pain is the first thing to leave. Movement and strength are the last things trained back, and most people stop before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is actually limiting you, treats it in the same appointment, and you leave with your current stage and a written plan.
Prefer to phone? Each of our five clinics has its own number on the clinics page. No referral needed to book.
Related reading
- physiotherapy after surgery
- ankle physiotherapy
- Ankle Pain From Running: Causes and How to Manage It
- What Are the Most Common Football Injuries?
- What Causes Heel Pain & Treatment Options
- The Phoenix Recovery Protocol, and the four stages
- All recovery programs, hand and physio
- Achilles Tendinitis Treatments: Comprehensive Guide
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