2. • A Lisfranc injury is a tarsometatarsal fracture dislocation characterized
by traumatic disruption between the articulation of the medial
cuneiform and base of the second metatarsal.
• Diagnosis is confirmed by radiographs which may show widening of
the interval between the 1st and 2nd ray.
• Treatment is generally operative with either ORIF or arthrodesis.
4. Mechanism of injury
• MVAs, falls from height, and athletic injuries
• injury cascade
• mechanism is usually caused by indirect rotational forces and axial
load through hyper-plantar flexed forefoot
• hyperflexion/compression/abduction moment exerted on forefoot
and transmitted to the TMT articulation
• metatarsals displaced in dorsal/lateral direction
5. • Anatomy
• Osteology
• Lisfranc joint complex consists of three articulations including
• tarsometatarsal articulation
• intermetatarsal articulation
• intertarsal or intercuneiform articulations
columns of the midfoot
• medial column
• includes first tarsometatarsal joint
• middle column
• includes second and third tarsometatarsal joints
• lateral column
• includes fourth and fifth tarsometatarsal joints (most mobile)
6. • Ligaments
• Lisfranc ligament
• an interosseous ligament that goes from medial cuneiform to base of 2nd metatarsal on plantar surface
• critical to stabilizing the 1st and 2nd tarsometatarsal joints and maintenance of the midfoot arch
• Lisfranc ligament tightens with pronation and abduction of forefoot
• plantar tarsometatarsal ligaments
• injury of the plantar ligament between the medial cuneiform and the second and third metatarsals along
with the Lisfranc ligament is necessary to give transverse instability.
• dorsal tarsometatarsal ligaments
• dorsal ligaments are weaker and therefore bony displacement with injury is often dorsal
• intermetatarsal ligaments
• between second-fifth metatarsal bases
• no direct ligamentous attachment between first and second metatarsal
