Lisfranc injuries are relatively rare, approximately 0.2% of all fractures, with an incidence of one per 55,000 persons yearly. These injuries are frequently misdiagnosed or there is a delay in the diagnosis. Treatment options published in the peer-reviewed literature are mostly retrospective case series (Level IV evidence). From the literature, the current recommendations of treatment emphasize anatomic reduction and rigid internal fixation. Concepts guiding this approach of treatment include: 1. Lisfranc injuries often disrupt the strong midfoot ligaments that help support the arch. Adequate healing of these ligaments requires anatomic reduction and often prolonged immobilization. The Lisfranc ligament connects the base of the second metatarsal to the medial cuneiform and is the largest and strongest of the interosseous ligaments. 2. The severity of subtle Lisfranc injuries often is underestimated. Adequate healing of the ligaments stabilizing the Lisfranc joints may be prolonged. Patients should be provided with an accurate prognosis at the time of the initial diagnosis. 3. Major Lisfranc injuries may be missed initially, particularly if there are distracting concomitant injuries. A misdiagnosis or delay can result in serious complications such as amputation. 4. Displaced Lisfranc injury with compromised vascularity should be treated with prompt reduction of the joint. For patients with good vascularity, the status of the soft tissues should dictate the timing of definitive surgery. A delay of a few days or more is not uncommon to allow the soft-tissue swelling to decrease. 5. Anatomic reduction of the Lisfranc joint is one the most important factors in determining outcome. Rigid internal fixation with screws medially and Kirschner wires laterally allows stable healing. 6. Post-traumatic arthritis is related to articular damage and inadequate reduction. 7. Post-traumatic arthritis can be treated with a soft orthosis and a stiff-soled shoe with a rocker-bottom contour that accommodates the deformity and associated swelling. 8. Persistent pain and disability can be treated with arthrodesis of the involved joints as a salvage procedure. Primary arthrodesis of the Lisfranc joint in patients with purely ligamentous Lisfranc injuries is supported by a Level I study.