BACKGROUND: Open reduction and internal fixation or primary arthrodesis are considered gold standards for treating Lisfranc injuries. However, several drawbacks are associated with these procedures, such as joint motion loss and potential cartilage damage. More recently, the suture button emerged as an alternative treatment for ligamentous Lisfranc injuries, which can be used either alone or in combination with traditional techniques, with the potential to mitigate some of these potential disadvantages. The primary outcome of the present study was to evaluate the functional outcomes of 20 patients treated with the suture button technique for Lisfranc injuries over a medium- to long-term follow-up period. The secondary outcome was to assess and describe the complications associated with this procedure. METHODS: A retrospective review was conducted on 20 patients who underwent operation for acute Lisfranc injuries using the interosseous suture button technique between 2013 and 2019. The mean follow-up was 83 months (range 60-126). Clinical evaluation involved the assessment of complications, reoperations, visual analog scale (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scores, patient satisfaction, and ability to return to previous activities. Radiographic analysis was performed aiming to evaluate reduction maintenance and osteoarthritis development. RESULTS: Patients demonstrated excellent outcomes with an average VAS of 0.50 and a mean AOFAS midfoot score of 95.5. Incomplete reduction was the only factor we identified influencing lower VAS and AOFAS scores. Most complications were minor and solved with conservative treatment. More serious complications, such as loss of reduction and posttraumatic arthritis were observed in 2 patients each. CONCLUSION: In this small series with a relatively long follow-up, we found that the use of an interosseous suture button technique was a reliable method to treat acute Lisfranc injuries, resulting in satisfactory clinical and functional outcomes. However, outcomes including posttraumatic arthritis and loss of reduction raise remain of concern.