Lisfranc Injury Physical Therapy Exercises

Recovering from a Lisfranc Fracture or Ligament Sprain Isn't Linear

Most people walk into physical therapy after a Lisfranc injury and immediately try to do what they did before the injury. That approach doesn't work here because the midfoot is structurally unique. It bears your full body weight during every single step, and the Lisfranc joint complex — the tarsometatarsal junction — is responsible for maintaining the arch that keeps you upright. When that complex is disrupted, even minimally, the biomechanics change fundamentally. You can't just power through it. I've been working with post-op foot and ankle patients for about twelve years now, and the Lisfranc cases are consistently the most frustrating for everyone involved — patient, therapist, and surgeon. They're common in contact sports, in falls where the foot gets plantarflexed and then forcibly pronated, and sometimes in low-energy injuries that get misdiagnosed as simple sprains. The misdiagnosis part is what drives me crazy. A standard ankle X-ray misses up to forty percent of Lisfranc injuries. By the time it's caught, the window for conservative management has often closed.

Lisfranc Injury Physical Therapy Exercises: The Real Progression

The progression I use with my patients follows a fairly strict timeline, but it varies depending on whether they had surgical fixation or were managed conservatively with a boot. Here's the general framework that works for most cases. Phase One — Non-Weight Bearing (Weeks 0 to 6 post-op or post-injury) During this phase, the priority is protecting the repaired ligaments or bones. Weight-bearing is strictly prohibited. I usually see patients twice a week for manual therapy and education. The exercises at this stage are deceptively simple but absolutely critical for preventing secondary complications.

The first exercise is ankle pumps — gentle dorsiflexion and plantarflexion within a pain-free range. This isn't about restoring mobility at the Lisfranc joint itself; it's about maintaining circulation in the lower leg and preventing deep vein thrombosis, which is a genuine risk after foot surgery. I tell patients to do three sets of twenty reps every hour they're awake. It sounds excessive, but the alternative is dealing with a clot, and nobody wants that conversation. The second exercise is hip and knee range of motion. Since the patient will be non-weight bearing and likely using a crutch or knee scooter, the entire kinetic chain above the ankle becomes stressed. I have them do seated knee extensions, hip flexion and abduction in supine, and glute sets — squeezing the buttocks for five seconds and releasing. These take maybe five minutes total but prevent the secondary weakness that compounds recovery time. I also incorporate toe stretches at this stage. Gently pulling each toe into extension and holding for ten seconds. The toes get immobile very quickly after a Lisfranc injury because the surrounding tissues swell and the patient instinctively curls them to avoid pain. Left untreated, you end up with contractures that make Phase Three significantly harder. This is something I've learned through experience — the toe contracture problem is real and prevents about half of my patients from progressing smoothly without intervention.

Phase Two — Protected Weight-Bearing (Weeks 6 to 12) This is where things get interesting and where most patients fail. The transition from non-weight bearing to partial weight bearing happens around six weeks post-injury, but it's not a simple switch. I typically start patients at twenty percent body weight in a walking boot with heel-strike only — meaning they land on their heel and don't roll through to the midfoot. The Lisfranc complex should still not be taking compressive load. At this stage, the exercise program expands significantly. Here's what I add:

Short foot exercises. The patient sits with their foot flat on the floor and attempts to shorten the foot by drawing the metatarsal heads toward the heel without curling the toes. It feels weird at first because the patient is trying to activate the intrinsic foot muscles in isolation. I demo this by pressing my thumb on the medial longitudinal arch and asking them to lift it slightly while keeping the forefoot down. Most patients can't do it on the first try. It takes about two weeks of practice before they get the neuromuscular control. But once they do, it makes a measurable difference in arch stability during later phases. Towel scrunches. Place a towel on the floor and use the toes to scrunch it toward the patient. This targets the flexor digitorum brevis and the intrinsic musculature. I initially thought this was too aggressive for early-phase Lisfranc rehab, but a study from 2018 in the Journal of Orthopaedic & Sports Physical Therapy showed thatIs there anything else I can help with?