The midfoot is a unique complex of bony and ligamentous structures critical for normal function of the foot. The midfoot extends from the Chopart to the Lisfranc articulations. Injuries can occur from both high- and low-energy mechanisms, and subtle injuries can be easily missed without an appropriate index of suspicion and adequate imaging. The goals of treatment for midfoot injuries include deliberate management of the soft tissue envelope and restoration of bony alignment, length, and stability. The medial and middle columns should have bony alignment secured with joint sparing versus arthrodesis procedures. The lateral column should have length restored with an attempt to maintain flexibility. Midfoot fractures and fracture/dislocations are inherently difficult injuries to treat. Thoughtful setup of the patient, the operating room, and the back table are critical. Soft tissue management should include preop evaluation, early reduction of any skin-threatening deformities/dislocations, allowing for swelling to reduce preoperatively with splinting, and comprehensive surgical incision planning. Exposing all the injuries, working systematically across the foot, and provisional fixation with reduction clamps and K-wires all help restore a stable plantigrade foot.