Abstract: Objective To explore the guiding role of three column theory in the diagnosis and treatment of complex fracture and dislocation of middle foot. Methods From January 2013 to September 2017, 24 cases with complicated foot injuries in Chengdu First People's Hospital were treated, including 8 females and 16 males, aged 18-57 years with an average of 41 years. According to the functional anatomy of three columns theory, 6 cases were injured in medial column, 6 cases in intermediate column combined with medial column, and 12 cases in three columns. Inter-articular long plate was used to rigidly fix the medial column and the intermediate column, and Kirschner wire was used to fix the lateral column elastically. According to the need of fixation, screws were used during the operation. If the fracture was accompanied by shortening of scaphoid or cuboid bone of medial column foot or lateral column, open and reposition was needed, then cross-articular plate was fixed. Bone graft would be implanted if necessary,so as to reconstruct the length of each column and maintain the normal structure and function of the arch of the foot. Postoperative imaging and clinical follow-up were performed to evaluate the alignment of midfoot and fracture healing, and the curative effect was evaluated by Mariland Foot Score Scale. The VAS pain scale was used to assess the pain level at the site of injury. Results After 12-month follow-up, one patient had limp because of poor recovery of scaphoid comminuted fracture in the medial column, and the gait was restored to normal after removal of internal fixation. The other 23 patients achieved satisfactory results. The foot arch was normal in weight bearing, with normal walking function. No plate screw failure, infection and other complications occurred. The final follow-up showed that all fractures of the midfoot healed with normal and stable structure and normal alignment. The average Mariland's foot score was 94(70-98) in 19 cases achieved excellent, 2 cases were good, and 3 cases were fair. The average VAS score was 1.2(0-2). Conclusion Under the guidance of three-column theory, timely operation, accurate anatomical reduction during operation, different ways to fix the medial column, intermediate column and lateral column according to different fixed strength,restore the normal anatomical structure and function of the arch and early functional exercise after operation, are all helpful to obtain satisfactory clinical outcomes for complex fracture and dislocation of midfoot.