Lisfranc injuries encompass a variety of trauma to the midfoot. These range from lowenergy mechanisms to high-energy crush injuries. No single approach is appropriate for all injury patterns. Current controversy has focused on the decision to “fix or fuse” the midfoot when treating a Lisfranc injury. This concept is an overly simplistic thought process for such a complex variety of soft tissue and bony injury patterns. Minimally invasive approaches to these injuries decrease the risk of further soft tissue trauma and allow for satisfactory reduction and stabilization in certain low-energy injury patterns. Additionally, patients comorbidities including diabetes, vascular disease, smoking, multitrauma may drive the surgeon to seek less invasive techniques to avoid wound complications while achieving the goals of creating a stable midfoot. The goal of the chapter is to delineate the indications and review the technique of a minimally invasive approach to Lisfranc injuries.