Subtle Lisfranc injuries are commonly overlooked, and the severity of the injury is often underestimated. Lisfranc injuries can cause severe pain and debilitation if missed and not treated. Patients with midfoot pain following even a minor trauma should be evaluated for a Lisfranc injury with bilateral weightbearing radiographs when they are able to tolerate. There should be a low threshold for open reduction with internal fixation in the active, healthy patient population. Surgical technique is described. Primary fusion may be considered in more severe cases as well as those where the diagnosis is delayed.