Subtle Lisfranc instability is typically a low-energy, twisting, axial-loading injury. The present study evaluated the operative treatment of subtle Lisfranc injuries after nonoperative failure. The data from consecutive patients with subtle Lisfranc instabilities were reviewed. Those in whom initial nonoperative treatment had failed underwent surgery. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score was obtained initially, after nonoperative treatment, and, for those in whom nonoperative treatment had failed, after operative treatment. Of 36 patients enrolled, 16 (44.44%) were successfully treated nonoperatively, and 20 (55.56%) required surgery after nonoperative treatment had failed. Of those treated operatively, 9 (45%) were stabilized with dual screws and 11 (55%) with dual suture buttons. The mean follow-up period was 36 ± 12.2 months. The AOFAS scores significantly improved from the pre- to final post-treatment values. The overall mean pretreatment AOFAS score (62.8 ± 8.84) was significantly lower statistically than the mean overall post-treatment AOFAS score (91.3 ± 8.34;​ p < .0001). The mean AOFAS score before nonoperative treatment (61.9 ± 9.5) improved to a mean AOFAS score of 75.3 ± 15.8 after nonoperative treatment (p = .0029). The mean preoperative AOFAS score (63.5 ± 8.46) improved to a postoperative AOFAS score of 92.3 ± 8.43 (p < .0001). The mean AOFAS score before nonoperative treatment (61.9 ± 9.5) was not significantly different statistically from the mean preoperative AOFAS score (63.5 ± 8.46;​ p = .62). The mean AOFAS score after nonoperative treatment (75.3 ± 15.8) was lower than the mean postoperative AOFAS score (92.3 ± 8.43;​ p < .0001). Of the 9 feet stabilized with dual screws, 7 (77.78%) required screw removal during the observation period. Subtle Lisfranc injuries failing nonoperative treatment were successfully stabilized using either a dual screw or suture button technique.

Level of Clinical Evidence:​ 4