The fourth tarsometatarsal ligament connects the fourth metatarsal base to the cuboid, forming part of the lateral column ligamentous complex. The fourth CMC joint is more mobile than the central joints, allowing approximately 10-15 degrees of plantarflexion.
Provides stability to the fourth TMT articulation while allowing functional mobility for lateral column adaptation during walking on uneven surfaces.
The fourth TMT joint is less commonly injured in isolation than the medial joints but is involved in complete Lisfranc disruptions. Its greater mobility means it often reduces spontaneously after dislocation.
Fourth TMT joint involvement in complete divergent Lisfranc dislocation requiring reduction and fixation to restore lateral column stability.
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