The dorsal tarsometatarsal ligaments are thinner and weaker than the plantar ligaments, failing first in Lisfranc mechanisms. The dorsal Lisfranc ligament (medial cuneiform to second metatarsal) is absent (the Lisfranc ligament is entirely plantar and interosseous), explaining why the second metatarsal lacks dorsal ligament support between the first and second cuneiforms — this structural gap is why the second TMT is the most common dislocation site.
| Origin | Dorsal surfaces of the cuneiforms and cuboid |
|---|---|
| Insertion | Dorsal bases of the metatarsals |
| Actions | Secondary TMT stabilisers; weaker than plantar equivalents — fail first in Lisfranc injuries |
|---|
The absence of a dorsal Lisfranc ligament at the first-second intermetatarsal space creates the vulnerability of the Lisfranc complex to dorsal dislocation. Stress radiographs with forefoot abduction and dorsiflexion open the second TMT gap in unstable Lisfranc injuries.
Dorsal TMT ligament failure producing metatarsal dorsal displacement managed with closed or open reduction and fixation.
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