Bilateral Lisfranc fractures are rare and often associated with complex soft tissue and neurological involvement, posing significant diagnostic and therapeutic challenges. This study aimed to evaluate the clinical and neurological outcomes of patients with bilateral Lisfranc fracture–dislocations complicated by peripheral nerve injury, and to propose an integrated management approach emphasizing early neurological assessment and rehabilitation.

A prospective observational study was conducted involving 12 adult patients (mean age 36.4 years) presenting with bilateral Lisfranc injuries following high-energy trauma. All patients underwent standardized imaging with computed tomography and electromyographic assessment to identify associated nerve damage, primarily involving the deep peroneal and tibial nerves. Surgical fixation was performed using open reduction and internal fixation with trans articular screws or dorsal bridge plates, followed by staged neurological rehabilitation. Postoperative outcomes were evaluated over 12 months using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, nerve conduction velocity testing, and functional independence measures.

Results demonstrated that 75% of patients achieved satisfactory fracture union within 14 weeks, with significant improvement in mean AOFAS scores from 42.6 preoperatively to 82.3 at one year. Peripheral nerve recovery was partial in 8 patients and complete in 3, with persistent sensory deficits in one case. Early identification of nerve involvement and initiation of neuromodulatory therapy correlated with improved sensory and motor recovery. Patients receiving combined orthopaedic and neurological follow-up exhibited faster functional return and reduced chronic pain scores compared to those with delayed neurological intervention.