tarsometatarsal

The tarsometatarsal joints are a set of joints in the foot where the distal row of tarsal bones (the cuneiforms and the cuboid) articulate with the bases of the metatarsal bones. There are five tarsometatarsal joints: the first between the first metatarsal base and the medial cuneiform, the second between the second metatarsal base and the intermediate cuneiform, the third between the third metatarsal base and the lateral cuneiform, and the fourth and fifth between the fourth and fifth metatarsal bases and the cuboid. The Lisfranc joint complex typically denotes the articulation between the medial cuneiform and the base of the second metatarsal. This region is reinforced by several ligaments, most notably the Lisfranc interosseous ligament, which runs obliquely between the medial cuneiform and the base of the second metatarsal, along with dorsal and plantar ligaments that stabilize the joints.

Functionally, the tarsometatarsal joints help stabilize the midfoot and transmit forces from the hindfoot to the forefoot during weight bearing and propulsion, contributing to the integrity of the transverse arch and the overall foot mechanics.

Injuries to this region, often termed Lisfranc injuries, range from ligament sprains to fracture-dislocations. They commonly result from axial loading on a plantarflexed foot or a twisting injury and present with midfoot pain, swelling, and difficulty bearing weight. Diagnosis relies on weight-bearing radiographs; CT is useful for fracture patterns, and MRI can assess soft-tissue injury.

Treatment depends on stability and displacement. Stable, non-displaced injuries may be managed with immobilization and protected weight bearing. Displaced or unstable injuries typically require surgical intervention, such as open reduction and internal fixation with screws or plates, or, in selected cases, primary fusion. Complications can include chronic pain, instability, and post-traumatic osteoarthritis.