Richmond & Kensington, London
Lisfranc Injury Assessment
& Treatment
Expert assessment and rehabilitation for Lisfranc and midfoot injuries by HCPC-registered podiatrists. Reducing pain, restoring stability and getting you back to full activity.
HCPC Registered
Treadmill Gait Analysis
Bespoke Rehab Programmes
No Referral Needed
A Lisfranc injury involves damage to the bones, ligaments or joints in the midfoot — specifically the tarsometatarsal (TMT) joint complex, also known as the Lisfranc joint. The injury ranges from a simple ligament sprain to a complex fracture-dislocation involving multiple bones and joints of the midfoot.
Lisfranc injuries are frequently misdiagnosed as simple sprains, particularly in the early stages. This is significant because an unrecognised or poorly managed Lisfranc injury can lead to chronic midfoot instability, post-traumatic arthritis and long-term disability. Early, accurate assessment is essential for the best possible outcome.
The Lisfranc joint complex — tarsometatarsal articulations of the midfoot
Type 1
Ligament Sprain
Partial or complete tear of the Lisfranc ligament without bony displacement. Midfoot is stable. Often managed conservatively with immobilisation and rehabilitation.
Type 2
Partial Dislocation
One or more metatarsals are partially displaced from their normal position. There may be associated small avulsion fractures. Stability is compromised and careful management is required.
Type 3
Complete Dislocation
Complete displacement of the tarsometatarsal joints. Often associated with significant fractures. This is the most severe form and typically requires surgical referral for fixation.
Variant
Stress / Occult Lisfranc
A subtle Lisfranc injury with no obvious displacement that can be missed on standard X-ray. Common in athletes with gradual-onset midfoot pain. Weight-bearing imaging or MRI is often required to identify.
Common Causes
Direct trauma — fall or crush injury to the foot
Twisting injury with a fixed forefoot
Sports collision or tackle
Horse riding or equestrian accidents
Stepping into a hole or off a kerb
Repetitive overloading in runners or dancers
Motor vehicle accidents
Signs & Symptoms
Midfoot pain, particularly on the top of the foot
Swelling across the midfoot
Bruising on the sole of the foot (key sign)
Pain when bearing weight or walking
Midfoot instability or giving way
Pain worsening with activity
Visible deformity in severe cases
Accurate assessment is the most critical step in managing a Lisfranc injury well. Because these injuries are frequently missed or underestimated, a thorough clinical examination is essential. We take a detailed history of the mechanism of injury, assess midfoot stability, and evaluate your walking pattern using our treadmill with Onform joint tracking software — which allows us to show you exactly where instability or compensatory movement is occurring.
Where imaging is required to confirm the diagnosis or assess severity, we will refer you for weight-bearing X-rays, CT or MRI scans. We work closely with radiologists and orthopaedic surgeons where surgical assessment is needed.
01
Clinical Assessment & Diagnosis
Detailed history taking, clinical examination of midfoot stability, and gait analysis using our treadmill and Onform software. We identify the likely severity and mechanism of injury and advise on whether imaging is required before proceeding with treatment.
02
Imaging Referral (Where Required)
Where clinical findings suggest a significant injury, we will refer for appropriate imaging — typically weight-bearing X-rays as a first line, with CT or MRI where further detail is needed. Weight-bearing views are essential as Lisfranc injuries can be occult on non-weight-bearing films.
03
Immobilisation & Offloading
For stable ligamentous injuries without displacement, a period of immobilisation in a walking boot is usually the first line of management. This protects the joint complex while healing begins and reduces the risk of the injury progressing. Duration depends on severity — typically 6–8 weeks.
04
Custom Orthotics & Footwear Advice
Once the acute phase has settled, custom orthotics are often prescribed to support the midfoot arch, redistribute load away from the injured joint complex and control abnormal motion during walking and running. We design orthotics based on your specific gait assessment findings.
05
Rehabilitation Programme
A progressive rehabilitation programme addressing midfoot strength, proprioception, balance and sport-specific movement patterns. We use Onform to track your movement quality and show you improvements in real time. Rehab is graded carefully to avoid setbacks and progress you towards your goals.
06
Surgical Referral (Severe Cases)
For unstable or displaced Lisfranc injuries that require surgical fixation, we will refer you to a trusted orthopaedic foot and ankle surgeon. We coordinate your care and provide pre- and post-operative podiatric support to optimise your recovery.
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Specialist sports podiatry experienceWilliam Joyce has worked with elite athletes, professional footballers and Red Bull-sponsored athletes — experience that matters for complex foot injuries.
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Treadmill gait analysis with OnformJoint tracking and visual overlays to objectively assess instability and movement compensation — and show you what's happening in real time.
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Custom orthotics in-houseBespoke orthotic prescription based on your specific gait and injury findings — not off-the-shelf solutions.
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Trusted surgical referral networkWe refer to experienced orthopaedic foot and ankle surgeons when needed and support you through pre- and post-operative care.
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HCPC-registered podiatristsFully qualified and regulated practitioners providing safe, evidence-based care.
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Insurance acceptedWe work with Bupa, Aviva, WPA and most major private health insurers.
How do I know if I have a Lisfranc injury or just a sprain?
This is one of the most common and important questions with midfoot injuries. Key warning signs of a Lisfranc injury include bruising on the sole of the foot (plantar ecchymosis), inability to bear weight, pain specifically over the midfoot rather than the ankle, and swelling across the top of the foot. However, mild Lisfranc injuries can be genuinely difficult to distinguish from a simple sprain without clinical examination and imaging. If you have significant midfoot pain after a twisting injury, it is worth getting it properly assessed.
Can a Lisfranc injury heal without surgery?
Yes — many Lisfranc injuries, particularly stable ligamentous sprains without displacement, can heal well with conservative management including immobilisation, offloading and rehabilitation. However, unstable or displaced injuries typically require surgical fixation for the best long-term outcome. The key is accurate diagnosis early — delayed or missed diagnosis significantly worsens outcomes even for injuries that could have been managed conservatively.
How long does recovery take?
Recovery time varies considerably with injury severity. A mild ligamentous sprain may settle in 6–12 weeks with appropriate management. More significant injuries typically require 3–6 months before return to sport or high-level activity, and some patients experience ongoing symptoms for 12 months or more. We will give you a realistic timeline based on your specific injury at your assessment.
Will I develop arthritis after a Lisfranc injury?
Post-traumatic arthritis in the tarsometatarsal joints is a recognised complication of Lisfranc injuries, particularly those that were unstable, displaced or diagnosed late. The risk is significantly reduced with accurate early diagnosis and appropriate management. Orthotics and footwear modifications can help manage symptoms if arthritis does develop.
Can I use private health insurance?
Yes — we work with most major private health insurers including Bupa, Aviva and WPA. Please check your policy before booking and obtain an authorisation code if required. See our
Insurance page for full details.
Do I need a GP referral?
No — you can book directly online or by phone without a GP referral. Some health insurers may require a referral letter before authorising treatment, so check your policy if you are claiming through insurance.
Book your midfoot assessment today
Richmond and Kensington clinics available. No referral needed — expert assessment at your first visit.
