Treatment of subtle or athletic Lisfranc injuries continues to evolve. Increased recognition of this condition and newer surgical techniques have lead to significant improvements in treatment. Traditionally, screw fixation, which requires a second surgery for screw removal, has been the gold standard. The introduction of adjustable suture button fixation provides an alternative method for these subtle injuries. The adjustable suture button does not require subsequent hardware removal. The original description of this technique used 1 adjustable suture button connecting the medial cuneiform to the second metatarsal base. We modified this technique to address rotational stability by adding a second adjustable suture button to connect the medial cuneiform to the middle cuneiform.