The dorsal intermetatarsal ligaments are short transverse bands connecting the dorsal surfaces of adjacent metatarsal bases, complementing the deeper plantar intermetatarsal ligaments and the interosseous metatarsal ligaments in stabilising the Lisfranc complex. They are thinner and weaker than the plantar equivalents, explaining why Lisfranc injuries typically produce dorsal displacement of the metatarsals rather than plantar displacement.
| Origin | Dorsal surface of a metatarsal base (second to fifth) |
|---|---|
| Insertion | Dorsal surface of the neighbouring metatarsal base |
Resist dorsal separation of adjacent metatarsal bases, contribute to the Lisfranc complex dorsal stability, and complement the stronger plantar counterparts in maintaining the transverse midfoot arch at the tarsometatarsal level.
The dorsal intermetatarsal ligaments are weaker than their plantar equivalents, which is why the second metatarsal base displaces dorsally and laterally in Lisfranc injuries. The plantar Lisfranc and the interosseous ligaments are stronger, preferentially injuring the dorsal ligaments first. In surgical stabilisation of Lisfranc injuries, the dorsal ligament remnants are assessed and the dorsal reduction is confirmed under fluoroscopy. Chronic Lisfranc instability with midfoot OA requires arthrodesis of the first through third TMT joints.
The dorsal TMT and intermetatarsal ligaments fail before the stronger plantar structures in Lisfranc dislocation, allowing the second metatarsal base to displace dorsally and laterally relative to the middle cuneiform; weightbearing AP foot radiograph demonstrating more than 2 mm diastasis between the first and second metatarsal bases confirms the injury.
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