Lisfranc fracture dislocations are uncommon foot injuries and can be difficult to diagnose clinically and radiographically. Associated dislocation of the medial cuneiform is rare and also is difficult to diagnose. We present a case of combined Lisfranc and medial cuneiform fracture dislocation; the dislocation of the medial cuneiform was overlooked on initial radiographs. Subsequent CT examination showed the degree of midfoot disruption better than plain radiographs.