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We break down a real clinic case where a simple misstep leads to a suspected Lisfranc injury and a fast track from urgent imaging to surgical care. We share the exam and X-ray clues that help us spot midfoot instability early, plus what recovery often looks like after fixation.
• case presentation after a plantar-flexion misstep with a pop and immediate inability to weight bear
• key exam findings including diffuse midfoot oedema, focal medial midfoot tenderness, and pain with forefoot compression and rotation
• X-ray alignment changes that raise concern for Lisfranc disruption and why CT helps define the injury
• Lisfranc ligament anatomy and why plantar arch bruising can be a high-value clinical sign
• when non-operative care may fail and why surgical referral is common with widening and instability
• post-op course including splinting, casting, strict non-weight bearing, and gradual return in a walking boot with physical therapy
• realistic healing timeline, persistent swelling, and practical counselling points for patients