A Lisfranc injury/fracture is a disruption of the articulation of the medial cuneiform and the base of the second metatarsal. The injury can vary from a mild sprain to a severe dislocation. There are both bony injury and purely ligamentous patterns of the injury. Missed injuries can lead to significant foot deformity, chronic pain, arthritis, and dysfunction due to the disruption of the normal “keystone configuration” of the osseous structure. A provocative test that usually produces pain if the injury is present is pronation and abduction of the forefoot. A common finding is plantar ecchymosis.