We present a case of a 10-year-old girl who sustained a Lisfranc fracture-dislocation after an all-terrain vehicle accident. She underwent open reduction and internal fixation with smooth Kirschner wires. At 5-year follow-up, she had developed functional pain and radiographic evidence of degenerative arthritis and partial fusion of her midfoot. There are several possible explanations for this outcome, including loss of reduction, traumatic or iatrogenic physeal injury, and severity of initial injury. Long-term outcomes in children with Lisfranc injuries are not well described. Our case may begin to shed light on the natural history of these injuries in the pediatric population, with the consideration of potential treatment implications and pitfalls.