Lisfranc Fusion

The Lisfranc complex refers to a group of joints, bones, and strong ligaments located in the midfoot, where the long bones of the foot (metatarsals) connect to the arch bones (tarsal bones). This complex plays a critical role in maintaining the stability and shape of the foot’s arch and in transferring forces during walking and push-off. Within this complex, the Lisfranc ligament further stabilizes the midfoot and prevents abnormal separation of the bones.¹

A Lisfranc injury occurs when these joints or ligaments are damaged, leading to instability of the midfoot. Injuries can range from ligament sprains to fractures and joint dislocations and may result from high-energy trauma (such as car accidents or falls) or lower-energy twisting injuries during sports. These injuries commonly manifest as midfoot pain, swelling, difficulty bearing weight, and sometimes bruising on the sole of the foot. Without proper treatment, they can progress to midfoot arthritis, causing chronic pain and arch collapse.^1
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When non-operative management fails to stabilize the foot and control pain, a Lisfranc joint fusion may be indicated.

Lisfranc joint fusion (arthrodesis) is performed to permanently stabilize the midfoot by fusing selected tarsometatarsal joints, most commonly the first, second, and third joints. During the procedure, the injured joints are typically accessed through one or two incisions on the top and inner side of the foot. The remaining cartilage is then removed from the joint surfaces, and the underlying bones are carefully prepared, realigned into their proper anatomical position, and temporarily held in place, as fixation is applied with screws and plates to compress and secure the joints, allowing them to heal into a single, stable unit.

Fusion is focused on the inner and middle portions of the midfoot, which are essential for strength and stability, while the outer joints may be temporarily stabilized if needed to preserve flexibility. This technique aims to restore stability to the midfoot while maintaining the normal arch, which helps reduce pain and prevent long-term problems such as arch collapse or worsening arthritis.²

Lisfranc fusion generally provides good long-term outcomes, but as with any surgery, complications may occur. Some of the most common ones include:
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● Post-traumatic arthritis (≈ 37%): degenerative changes in adjacent joints following trauma, which may manifest as ongoing chronic pain and disability
● Hardware irritation or removal (≈ 18–26%): discomfort from screws or plates requiring removal
● Nonunion (< 10%): failure of the Lisfranc complex bones to fuse
● Malunion (≈ 1–3%): abnormal alignment of the fused bones
● Neuritis (< 10%): sensory disturbance or pain at the surgical site, often transient ^3-6

The rates of each complication similarly vary depending on the surgical technique, nature of the underlying injury (e.g. acute or chronic), and patient-related factors. As for other surgeries, general risks related to surgery and anesthesia may include infection (<10%)^3,5, bleeding, blood clots, allergic reactions, cardiopulmonary complications, and wound-healing issues. Any general surgical and anesthesia-related risks can be discussed with you prior to surgery if applicable.

Before surgery, your surgeon will examine your foot and obtain X-rays with potential advanced imaging (e.g. CT scan), mainly to assess joint alignment and degeneration. Lisfranc fusion is typically performed under regional anesthesia (e.g. nerve block), sometimes with sedation, or under general anesthesia, often depending on patient-specific factors.⁷

After surgery, your foot will be immobilized in a splint or boot to protect the fusion site. Pain is usually managed with a combination of acetaminophen and anti-inflammatory medications, with stronger pain medication used briefly if needed.

Most patients go home the same day following Lisfranc fusion. Keeping the foot elevated during the first one to two weeks helps reduce swelling and promote healing, and stitches are typically removed after about two weeks.

During the first 6 weeks, the foot is usually kept immobilized in a splint or boot as weightbearing is avoided to reduce midfoot loading and protect the fusion, while early gentle ankle motion may be allowed. 

By the end of the second month, radiographic assessment is performed to confirm fusion progress and transition to partial weightbearing starts, in an aim to progress to full weightbearing and regular daily activities by 3 months provided fusion is confirmed and pain is controlled.

For athletes and highly active individuals, return to full sport or high-impact activities usually occurs within 4–7 months after the uncomplicated procedure, but some may require up to 9 months to fully return to sports. Functional improvement typically continues up until the first year following surgery.<sup>4,8-10

‍</sup>Throughout your healing journey, follow-up visits with your surgeon ensure proper healing and guide your safe return to activity at each stage of recovery.

Welck MJ, Zinchenko R, Rudge B. Lisfranc injuries. Injury. 2015;46(4):536-541. doi:10.1016/j.injury.2014.11.026
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Jonard B, Wroblewski A, Junko J. LisFranc Fusion. J Orthop Trauma. 2019;33 Suppl 1:S42-S43. doi:10.1097/BOT.0000000000001542
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Sinkler MA, Benedick A, Kavanagh M, Alfonso N, Vallier HA. Complications and Outcomes After Fixation of Lisfranc Injuries at an Urban Level 1 Trauma Center. J Orthop Trauma. 2024;38(5):e169-e174. doi:10.1097/BOT.0000000000002780
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Saxena A, Arthur WP, Ratnala D, Ashraf S, Malay DS. Arthrodesis in Acute and Chronic Lisfranc's Patients: A Retrospective Cohort Study. J Foot Ankle Surg. 2022;61(3):471-478. doi:10.1053/j.jfas.2021.08.013
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Barnds B, Tucker W, Morris B, et al. Cost comparison and complication rate of Lisfranc injuries treated with open reduction internal fixation versus primary arthrodesis. Injury. 2018;49(12):2318-2321. doi:10.1016/j.injury.2018.10.002
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Boffeli TJ, Collier RC, Schnell KR. Combined Medial Column Arthrodesis with Open Reduction Internal Fixation of Central Column for Treatment of Lisfranc Fracture-Dislocation: A Review of Consecutive Cases. J Foot Ankle Surg. 2018;57(6):1059-1066. doi:10.1053/j.jfas.2018.03.026
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Sharrow CM, Elmore B. Anesthesia for the Patient Undergoing Foot and Ankle Surgery. Clin Sports Med. 2022;41(2):263-280. doi:10.1016/j.csm.2021.11.010
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Webber KJ, Balboni JM, Semelsberger SD, et al. Return to sport following Lisfranc injuries in elite athletes-2024 international foot and ankle sports consensus and systematic review. Knee Surg Sports Traumatol Arthrosc. Published online January 26, 2026. doi:10.1002/ksa.70285
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Feldman MW, Fucaloro S, Krivicich L, Kent S, Salzler MJ. Studies directly comparing Lisfranc injuries treated with primary arthrodesis or open reduction and internal fixation show no significant difference in return to sport and complications: A systematic review and meta-analysis. J Foot Ankle Surg. 2025;64(3):318-327. doi:10.1053/j.jfas.2025.02.005
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Dong W, Sroka O, Campbell M, et al. Recovery Curves for Lisfranc ORIF Using PROMIS Physical Function and Pain Interference. J Orthop Trauma. 2024;38(5):e175-e181. doi:10.1097/BOT.0000000000002787