Background <p>Elastic fixation represents a novel approach to managing Lisfranc injuries. This study aims to evaluate the clinical efficacy of elastic fixation for such injuries using imaging, clinical evaluation indices, and plantar pressure analysis.</p> Methods <p>This retrospective study included 15 patients with isolated ligamentous Lisfranc injuries who underwent elastic fixation between October 2022 and July 2024.Follow-up lasted ≥ 6 months. Weight-bearing foot X-rays were taken at 1, 3, and 6 months postoperatively to assess joint reduction, degeneration, and implant stability. American Orthopaedic Foot and Ankle Society (AOFAS) scores and Foot Function Index (FFI) were collected preoperatively and at 1–6 months postoperatively. Plantar pressure distribution was also measured.</p> Results <p>Imaging showed stable reduction of the tarsometatarsal joints without degeneration or implant failure in all patients. Clinical scores improved significantly: AOFAS scores from 37.6 ± 6.75 to 92.9 ± 0.96 (<i>P</i> &lt; 0.0001), and FFI from 151.7 ± 9.31 to 10.1 ± 2.59 (<i>P</i> &lt; 0.0001) by 6 months postoperatively. Plantar pressure analysis revealed the affected foot’s pressure contribution increased from 20.4% preoperatively to 50.4% at 6 months postoperatively. By 2 months postoperatively, pressure distribution between both feet was balanced (<i>P</i> &gt; 0.05).</p> Conclusions <p>In this highly selected cohort, elastic fixation achieved excellent short-term functional recovery and allowed early weight-bearing. Owing to the small sample and short follow-up, these findings are exploratory and hypothesis-generating rather than definitive. Larger, longer-term studies are required to validate the safety and generalisability of the technique across broader patient populations.</p>