If there is a dislocation or bony injury, surgery is needed. If there are no fractures or dislocations in the joint and the ligaments are not completely torn, wear a non-weight-bearing cast or boot for 6 weeks.
A) PRICE-M (Acute treatment)
“Following diagnosis, the acute management of a tarsometatarsal (TMT) joint complex follows the standard approach (PRICE-M):
- Protection: Assuming no other injury, the injured foot is immobilized in a short-leg splint or boot.
- Rest: The patient is not permitted to bear weight on the injured extremity.
- Ice: Ice is applied to the affected midfoot.
- Compression: An appropriate dressing and elastic wrap are applied to the injured foot.
- Elevation: Whenever possible, the injured foot is kept above the level of the patient’s heart.
- Medication: Appropriate analgesia is provided.” Uptodate.com
B) Cast or boot (i.e. for Soft tissue injuries without dislocation)
“Ideally, this diagnosis is established using advanced imaging, typically magnetic resonance imaging (MRI). Initially, these patients are immobilized in a below-knee cast with non-weight-bearing restrictions. Weight-bearing plain radiographs are obtained every two weeks to ensure that proper alignment is maintained. Injuries that remain stable at six to eight weeks can be converted to a short-leg cast or Controlled Ankle Movement (CAM) boot. If the patient continues to experience pain with ambulation after 10 weeks of non-weight-bearing, repeat advanced imaging is often performed and the conservative management plan is reassessed based on the findings of the repeat study.
Once able to begin weight-bearing, patients with soft-tissue TMT joint injuries should be instructed to increase weight-bearing gradually. For the first two weeks, only partial weight-bearing in a CAM walker or short leg walking cast is allowed . The patient then increases the degree of weight-bearing in two-week intervals. A typical progression involves walking only around the house with no other activity permitted, then walking around the house combined with stationary bicycling every other day while remaining in a CAM boot, and finally unlimited walking with daily stationary bicycling. If pain recurs at any stage of rehabilitation, the patient should be re-evaluated and the previous, less demanding phase of rehabilitation resumed.
Patients perform physical therapy as part of their rehabilitation. Aquatherapy can begin as soon as the patient is out of their non-weight-bearing cast. Care should be taken to avoid full loading of the TMT joint even in the pool for up to 12 weeks. Supervised physical therapy is recommended to ensure that exercises are performed correctly and intensity levels are appropriate. Specific stretching exercises are included to help the patient regain full midfoot function. Custom-made orthoses, stiff sole inserts, or medial arch supports are generally used to protect the injured region depending on the preferences of the medical provider and therapist caring for the patient.” Uptodate.com
References
https://orthoinfo.aaos.org/en/diseases–conditions/lisfranc-midfoot-injury/
https://www.uptodate.com/contents/tarsometatarsal-lisfranc-joint-complex-injuries