The Lisfranc ligament is the strongest of the tarsometatarsal ligaments, connecting the medial cuneiform to the second metatarsal base and anchoring the keystone of the transverse arch. There is no direct interosseous ligament between the first and second metatarsal bases, making this the only interosseous connection between the medial and middle columns, so its disruption produces the characteristic lateral shift of all four lateral rays in a Lisfranc injury.
| Origin | Lateral surface of the medial cuneiform |
|---|---|
| Insertion | Medial surface of the base of the second metatarsal |
| Actions | Locks the keystone second metatarsal base into its cuneiform recess, stabilising the tarsometatarsal joint complex |
|---|
Lisfranc injuries range from isolated ligamentous sprains to complex fracture-dislocations and are among the most commonly missed injuries in the emergency department. The pathognomonic finding on weight-bearing radiographs is a diastasis between the first and second metatarsal bases greater than 2 millimetres. Even purely ligamentous Lisfranc injuries require surgical stabilisation because non-operative management consistently leads to chronic midfoot pain and deformity.
Disruption of the Lisfranc ligament with or without fracture producing tarsometatarsal instability, identified by diastasis on weight-bearing radiographs and requiring surgical fixation to prevent chronic midfoot collapse.
