The second tarsometatarsal (TMT) joint is the articulation between the base of the second metatarsal and the medial cuneiform, the intermediate cuneiform, and the lateral cuneiform. It is the most rigidly constrained TMT joint due to the recessed position of the second metatarsal base nestled between the first and third cuneiforms, making it the cornerstone of the Lisfranc complex. The Lisfranc ligament (interosseous ligament between the first cuneiform and second metatarsal base) is the primary restraint.
The second TMT joint is the key to Lisfranc joint complex integrity. In Lisfranc injuries, the second metatarsal base displaces from the intermediate cuneiform, disrupting the medial column stability. The injury is identified on weight-bearing AP radiograph by diastasis between the first and second metatarsal bases or by fracture of the second metatarsal base. Open reduction and internal fixation of Lisfranc injuries must anatomically restore the second TMT joint alignment. Malreduction by even 2 mm leads to midfoot arthrosis.
Axial loading on the plantar flexed foot disrupts the Lisfranc ligament between the first cuneiform and second metatarsal base, allowing dorsal or lateral displacement of the second metatarsal; subtle injuries may show only a diastasis on weight-bearing radiograph requiring ORIF with transarticular screws or bridge plating across the second TMT joint.
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