Background: Lisfranc injuries are complex tarsometatarsal joint disruptions, often resulting in chronic pain and disability if not accurately diagnosed and managed. This study evaluates the functional and radiological outcomes of various fixation methods for Lisfranc injuries and assesses their complications. Materials and methods: This prospective cohort study included 27 patients with acute Lisfranc injuries treated between January 2020 and December 2023. Patients were diagnosed using weight-bearing X-rays and CT scans. Treatment modalities included open reduction and internal fixation (ORIF) with screws or plates and minimally invasive K-wire fixation. Functional outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score at 6 and 12 months. Radiological outcomes were based on diastasis and tarsometatarsal sag. Statistical analysis included paired t-tests, Chi-squared tests, and regression analysis using SPSS version 26.0. Results: The mean AOFAS midfoot score improved from 78 at 6 months to 85 at 12 months. Screw fixation showed the highest scores (87 at 1 year), followed by dorsal plating (79) and K-wire fixation (72). Radiological analysis revealed better alignment (diastasis <2 mm, sag <15°) in screw fixation cases. Chronic pain (51.8%) and deformities (29.6%) were the most common complications, significantly lowering AOFAS scores. Conclusion: Screw fixation achieved superior functional and radiological outcomes, while dorsal plating provided moderate stability in severe cases. K-wire fixation demonstrated lower efficacy and higher rates of complications. Early intervention, anatomical reduction, and individualized treatment planning are key to optimizing outcomes.