Imaging Diagnostics of Lisfranc Joint Injuries

Abstract

Background

Lisfranc injuries are traumas to the tarsometatarsal joint, ranging from simple capsular ruptures to complex fracture-dislocations. Overall, these injuries are rare and may be underdiagnosed due to often subtle changes in initial imaging, requiring increased attention.

Method

This review provides an overview of the anatomy, injury mechanisms, classification, and diagnosis of Lisfranc injuries using case examples and relevant literature.

Results

The Lisfranc joint connects the fore- and midfoot and stabilizes the foot’s arch. It is stabilized by multiple ligaments, with the Lisfranc ligament complex between the medial cuneiform and the second metatarsal playing a crucial role. High-energy trauma often causes dislocation fractures, while low-energy sports injuries usually cause subtle ligament lesions that lead to chronic instability, pain and post-traumatic osteoarthritis if left untreated. Radiographs in three planes are used for initial diagnosis; if the findings are unremarkable and there is clinical suspicion, further weight-bearing X-ray, CT or MRI scans are required.

Conclusions

Lisfranc injuries are rare and often difficult to diagnose, but if left untreated, they can lead to long-term functional impairments and osteoarthritis of the Lisfranc joint complex, making targeted diagnostics essential.

Key Points

• Lisfranc injuries include a broad spectrum of tarsometatarsal joint injuries, from simple capsular ruptures to complex dislocation fractures. Subtle injuries require careful diagnosis to avoid long-term consequences such as osteoarthritis.

• Radiographs in three planes are used as standard diagnostics, whereby subtle, mostly ligamentous injuries are often overlooked.

• Weight-bearing X-ray and CT scans can help to detect subtle injuries to the ligamentous apparatus.

• In case of persistent complaints, an MRI scan also enables direct visualization of the ligaments.

Citation Format

• Freppon FN, Lammers OP, Kaul MG et al. Imaging Diagnostics of Lisfranc Joint Injuries. Rofo 2025; DOI 10.1055/a-2648-9756

Keywords

Foot - CT - MR-imaging - radiography - trauma

Publication History

Received: 13 April 2025

Accepted after revision: 25 June 2025

Article published online:
11 August 2025

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