From the archive · By David Abbasi, MD · August 25, 2022

Chet Holmgren's Lisfranc Injury, Explained

Chet Holmgren's foot injury was widely reported, and the term used for it — a Lisfranc injury — is one most people meet for the first time when an athlete sustains one. What follows is a general explanation of the injury, how it is assessed and how it is treated. It is not a diagnosis, and Mr. Holmgren is not a patient of this practice.

What a Lisfranc Injury Is

The injury takes its name from the Lisfranc joint, in the midfoot, where a cluster of small bones forms the arch across the top of the foot. The Lisfranc ligament binds those bones together and holds the arch in position. An injury there involves a fracture, a dislocation, or both, and it disturbs the structure that carries load across the middle of the foot.

Why It Is a Serious Injury in Sport

The midfoot transmits force every time the foot pushes off. When the Lisfranc joint loses its stability, the bones can spread apart under load, which causes pain and, over time, raises the risk of Arthritis in the joint. In a sport built on jumping and rapid changes of direction, that matters both for the immediate return to play and for the state of the foot years afterwards.

How It Is Treated

Treatment depends on whether the injury is principally a fracture or principally a ligament tear. A fracture can be realigned and held with screws or plates, and bone healing is comparatively predictable. A ligament injury is harder, because soft tissue heals less reliably and the repair is less stable in the early weeks. Where the joint is displaced, surgery aims to restore the alignment of the midfoot and hold it while healing takes place.

Recovery

Rehabilitation after a Lisfranc injury is long. It begins with a period off the foot entirely, moves to protected weight-bearing, and then to strengthening and to the movements the sport demands. The sequence is set by what the imaging and the examination show rather than by the calendar, and returning to load before the joint is ready risks the repair.

What Determines the Outcome

Lisfranc injuries vary widely, and so do the results. What is known is that the pattern of the injury, the accuracy of the alignment achieved, and the discipline of the rehabilitation all bear on it. Outcomes vary between people and cannot be guaranteed.

Why It Is Worth Understanding

A Lisfranc injury is easy to underestimate, because the early signs can look like an ordinary sprain of the midfoot. Swelling across the top of the foot, bruising on the sole, and pain on standing after a twisting injury are the features that warrant a proper examination and imaging rather than waiting to see whether symptoms resolve.

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