The tarsometatarsal (Lisfranc) ligament complex includes dorsal, plantar, and interosseous components connecting the cuneiforms and cuboid to the metatarsal bases. The interosseous Lisfranc ligament from the medial cuneiform to the second metatarsal base is the key stabiliser — its disruption produces the pathological diastasis between the first and second metatarsal bases diagnostic of Lisfranc injury.
| Origin | Cuneiform and cuboid distal surfaces |
|---|---|
| Insertion | Metatarsal bases (dorsal, plantar, and interosseous fibres) |
| Actions | Stabilise the tarsometatarsal (Lisfranc) joint against dorsal translation and diastasis; the plantar ligaments are stronger than the dorsal |
|---|
Lisfranc injuries range from pure ligamentous sprains to fracture-dislocations. Weightbearing AP foot radiograph shows the key finding: the medial second metatarsal base should align with the medial cuneiform lateral border. Greater than 2 mm of diastasis at the first-second metatarsal interval indicates ligamentous disruption requiring surgery. Primary arthrodesis of the medial column outperforms ORIF for pure ligamentous Lisfranc injuries in long-term outcome studies.
Tarsometatarsal ligament complex disruption producing first-second metatarsal diastasis managed with primary medial column arthrodesis or ORIF.
