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 |
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| Insertion | Medial surface of the base of the second metatarsal |
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Anchors the second metatarsal base to the medial cuneiform, 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. Diastasis between the first and second metatarsal bases greater than 2 millimetres on weight-bearing radiographs, or a fleck sign (a small avulsed bone fragment in the first intermetatarsal space), indicates injury. Unstable injuries, including purely ligamentous ones, need anatomical reduction and fixation, because untreated instability leads to chronic midfoot pain, arthritis and arch collapse. For purely ligamentous injuries, primary partial arthrodesis of the medial tarsometatarsal joints is an alternative to screw fixation with good outcomes.
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.
Small bony avulsion of the Lisfranc ligament from the medial cuneiform or second metatarsal base, a radiographic marker of significant Lisfranc injury.
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