Tarsometatarsal (Lisfranc's) fracture-dislocations account for 0.2% of all fractures. As many as 20% of these injuries are misdiagnosed or overlooked, especially in the polytrauma patient with other distracting injuries. The mechanism of injury, clinical diagnosis, treatment, and prognosis are reviewed. Results of arthrodesis of the tarsometatarsal joint for patients with symptomatic posttraumatic arthritis of the tarsometatarsal joint are discussed. A thorough understanding of this often misdiagnosed injury should facilitate the physician's prompt diagnosis and management of this potentially debilitating lesion, resulting in improved functional recovery for the patient.