Lisfranc Injury Exercises: Recovery Guide for Midfoot Injuries

A Lisfranc injury affects the midfoot where the metatarsal bones connect to the tarsal bones. These injuries range from mild sprains to severe fracture-dislocations requiring surgery. Rehabilitation is critical—improper healing can lead to chronic pain, arthritis, and disability.

Understanding Lisfranc Injuries

Anatomy

The Lisfranc joint complex:

• Location: Midfoot, where metatarsals meet tarsals
• Lisfranc ligament: Key stabilizer between medial cuneiform and 2nd metatarsal base
• Function: Transfers force during push-off, maintains arch stability

Injury Types

Sprains (Mild):

• Ligament stretched but intact
• No displacement on imaging
• 6-8 weeks non-operative treatment

Ligament tears with displacement:

• Partial or complete ligament rupture
• Bones shift out of alignment
• Usually requires surgery

Fracture-dislocations:

• Bones break and displace
• Severe instability
• Requires surgical fixation

Causes

• Twisting fall with foot planted
• Direct crush injury
• Sports (football, soccer, dance)
• Motor vehicle accidents
• Stumbling off a step or curb

Symptoms

• Midfoot pain and swelling
• Bruising on bottom of foot (pathognomonic)
• Pain with weight-bearing
• Unable to stand on toes on affected side
• Instability in severe cases

Why Rehab Matters

Poor rehabilitation leads to:

• Chronic midfoot pain
• Post-traumatic arthritis
• Flatfoot deformity
• Inability to return to sports
• Need for fusion surgery later

Phase 1: Protected Phase (Weeks 0-6)

Non-operative or post-operative: This phase involves immobilization. Exercise is limited but important for non-affected areas.

Goals:

• Protect healing structures
• Maintain strength elsewhere
• Control swelling
• Preserve joint mobility above and below

1. Toe Range of Motion

Keep toes mobile within cast/boot.

How to do it:

1. Wiggle toes gently
2. Flex and extend if able
3. 20-30 repetitions
4. Several times daily

2. Ankle Pumps (If Allowed)

Promotes circulation, prevents stiffness.

How to do it:

1. Move ankle up and down
2. Within boot/cast limits
3. 20-30 repetitions
4. Hourly when awake

3. Hip and Knee Strengthening

Maintain lower extremity strength.

Exercises:

• Quad sets: Tighten thigh, hold 10 sec
• Straight leg raises: 3 sets x 15 reps
• Side-lying hip abduction: 3 sets x 15 reps
• Prone hip extension: 3 sets x 15 reps

4. Core Exercises

Maintain fitness without loading foot.

Exercises:

• Bridges (on unaffected leg)
• Dead bugs
• Planks (modified on elbows and knees)
• Upper body resistance training

5. Elevation and Edema Control

How to do it:

• Elevate foot above heart level
• Ice around (not on) surgical site
• Compression as directed
• Critical in first 2 weeks

Phase 2: Early Mobility (Weeks 6-10)

Transition: Moving from non-weight-bearing to partial weight-bearing in boot.

Goals:

• Restore ankle and foot ROM
• Begin protected weight-bearing
• Progress strengthening

6. Ankle Range of Motion

How to do it:

1. Sit with leg extended
2. Move ankle: up/down, circles
3. Gentle movements only
4. 20-30 repetitions each direction
5. 2-3 times daily

7. Toe Flexion and Extension

How to do it:

1. Actively curl and straighten toes
2. 20-30 repetitions
3. Several times daily

8. Gentle Midfoot Mobilization

When cleared by surgeon.

How to do it:

1. Sit and place foot flat on floor
2. Gently rock foot side to side
3. Small movements
4. 1-2 minutes
5. Should not cause pain

9. Pool Walking (If Available)

Non-weight-bearing gait practice.

How to do it:

1. Walk in chest-deep water
2. Focus on normal gait pattern
3. 10-15 minutes
4. Excellent early exercise

10. Stationary Cycling (No Resistance)

How to do it:

1. When cleared for weight-bearing
2. Seat high, minimal foot pressure
3. Easy spinning only
4. 10-15 minutes
5. Progress duration before adding resistance

Phase 3: Progressive Loading (Weeks 10-16)

Transition: Full weight-bearing, transitioning out of boot.

Goals:

• Progress to full weight-bearing
• Restore strength and proprioception
• Return to regular footwear

11. Weight-Bearing Progression

How to do it:

1. Use crutches initially
2. Progress weight through foot gradually
3. Walk in boot first
4. Transition to supportive shoe
5. Normal gait pattern is the goal

12. Calf Raises (Bilateral)

How to do it:

1. Hold support for balance
2. Rise up on toes with both feet
3. Lower slowly
4. 3 sets x 15 repetitions
5. Progress: less hand support, more reps

13. Towel Scrunches

Intrinsic foot strengthening.

How to do it:

1. Place towel on floor
2. Scrunch toward you with toes
3. 2-3 minutes
4. Builds arch strength

14. Marble Pickups

How to do it:

1. Pick up marbles with toes
2. Place in container
3. 2-3 minutes
4. All toes involved

15. Short Foot Exercise

Key for arch stability.

How to do it:

1. Stand with foot flat
2. Raise arch without curling toes
3. Hold 5 seconds
4. 15-20 repetitions
5. Master this before progression

16. Single-Leg Balance

How to do it:

1. Stand on affected foot
2. Hold 30 seconds
3. Progress: eyes closed, unstable surface
4. 3-5 repetitions

17. Resistance Band Exercises

Exercises:

• Dorsiflexion (pull foot up)
• Plantarflexion (point foot down)
• Inversion (turn foot in)
• Eversion (turn foot out)
• 3 sets x 15 reps each direction

Phase 4: Advanced Strengthening (Weeks 16-24)

Goals:

• Full strength restoration
• Impact preparation
• Sport-specific training

18. Single-Leg Calf Raises

How to do it:

1. Stand on edge of step
2. Rise up on affected leg only
3. Lower heel below step
4. 3 sets x 15 repetitions
5. Critical for return to running

19. Step-Ups/Step-Downs

How to do it:

1. Start with 4-6 inch step
2. Step up leading with affected leg
3. Control step down
4. 3 sets x 12-15 repetitions
5. Progress step height

20. Walking Lunges

How to do it:

1. Controlled forward lunges
2. Good balance and alignment
3. 3 sets x 10 each leg
4. Pain-free range only

21. Jump Rope (Two Legs)

First impact exercise.

How to do it:

1. Start with low jumps
2. Land softly on both feet
3. 1-2 minutes
4. Progress duration

22. Box Jumps (Bilateral)

How to do it:

1. Low box (6-12 inches)
2. Jump up with two feet
3. Step down initially
4. Progress to jumping down
5. 3 sets x 10 repetitions

Phase 5: Return to Sport (Months 6+)

Goals:

• Sport-specific preparation
• Full return to activity
• Long-term management

23. Running Progression

Progression:

1. Walk/jog intervals on flat surface
2. Continuous jogging (15-20 min)
3. Running with increased pace
4. Hill running
5. Sport-specific running

24. Agility Drills

How to do it:

1. Lateral shuffles
2. Carioca
3. Figure-8s
4. Cutting and pivoting
5. Progress speed gradually

25. Plyometrics

Progression:

1. Two-leg hops
2. Single-leg hops
3. Lateral bounds
4. Depth jumps
5. Sport-specific explosive movements

26. Sport-Specific Training

Return to practice before competition:

• Start with non-contact drills
• Progress to limited contact
• Full return when cleared

Post-Surgical Considerations

After ORIF (Open Reduction Internal Fixation):

• Strict non-weight-bearing: 6-8 weeks typical
• Hardware removal sometimes needed later
• Follow surgeon's specific protocol

After Primary Fusion:

• Longer immobilization may be needed
• Never regain full midfoot motion
• Focus on compensation strategies

Footwear and Orthotics

After Lisfranc Injury:

• Stiff-soled shoes reduce midfoot stress
• Rocker-bottom soles help with push-off
• Custom orthotics support arch, limit motion
• Avoid: Flexible shoes, high heels, barefoot

Warning Signs

Contact your surgeon if:

• Increasing pain or swelling
• Hardware feels prominent or painful
• Signs of infection (fever, redness, drainage)
• Foot shape changing
• Unable to progress with weight-bearing

Long-Term Expectations

Typical Outcomes:

• Most return to daily activities fully
• Return to sport: 6-12 months
• Some residual stiffness common
• May need orthotics long-term
• Arthritis may develop over time (20-40%)

Factors Affecting Outcome:

• Injury severity
• Quality of initial treatment
• Compliance with rehabilitation
• Return to high-demand activities

Key Takeaways

1. Don't rush weight-bearing — Premature loading causes malunion
2. Follow the phases — Each builds on the previous
3. Footwear matters — Stiff soles protect midfoot
4. Expect a long recovery — 6-12 months is typical
5. Arthritis may develop — Even with good treatment
6. Strength and balance are key — Rebuild completely before impact

Lisfranc injuries are serious and require patience. The midfoot is critical for normal walking and running, so taking the time to rehabilitate properly prevents long-term problems. Work closely with your surgeon and physical therapist throughout recovery.