The Lisfranc ligament complex is the complete stabilising system of the tarsometatarsal (TMT) joints, comprising the true interosseous Lisfranc ligament (medial cuneiform to second metatarsal base), plus dorsal and plantar reinforcements at each of the five TMT joints.
Maintains the rigid midfoot architecture through the combined TMT ligament system, allows the slight motion needed for forefoot adaptation while providing the stiffness required for effective push-off, and distributes load across the transverse midfoot arch.
Lisfranc injuries exist on a spectrum from purely ligamentous (subtle) to fracture-dislocation (obvious). Weight-bearing AP foot radiograph showing greater than 2mm diastasis at the medial cuneiform-second metatarsal indicates ligamentous Lisfranc instability requiring surgical fixation. Primary arthrodesis for purely ligamentous Lisfranc injuries shows superior outcomes to screw fixation in athletes.
Purely ligamentous Lisfranc complex disruption without fracture, identified by weight-bearing radiographic diastasis, managed by primary arthrodesis of the medial two columns for athletes or screw fixation for recreational patients.
Complete Lisfranc complex disruption allowing lateral column lateral displacement and medial column medial displacement, requiring anatomic reduction and fixation of all involved TMT joints.
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