The fifth tarsometatarsal ligament connects the fifth metatarsal base to the cuboid, providing the most lateral TMT joint stabilisation. The fifth TMT joint has the greatest mobility (15-25 degrees of plantarflexion) of all five TMT joints.
Provides the most mobile TMT joint stability, allows the lateral column to adapt to terrain variation, and is the joint articulation at which the peroneus brevis inserts (styloid process).
The fifth TMT joint is the most mobile and least commonly injured in Lisfranc patterns. However, isolated fifth metatarsal base fractures (Jones fractures, avulsion fractures) involve the peroneus brevis insertion adjacent to this joint.
Peroneus brevis avulsion from the fifth metatarsal styloid process (Zone 1 fracture) involves the ligamentous attachment of the fifth TMT joint, managed conservatively unless widely displaced.
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