The Lisfranc Joint

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Anatomy

The Lisfranc joint is known to encompass the tarsometatarsal articulations. The most significant portion of the joint is the articulation of the medial surface of the second metatarsal base and the lateral joint surface of the medial cuneiform. The Lisfranc ligament spans this space and is crucial to the stability of the entire tarsometatarsal joint. Surrounding musculotendinous structures provide indirect stabilization to assist in stability of this complex joint.

Anatomically, the

Degenerative joint disease

Congenital foot structure plays an important role in the formation of nontraumatic degenerative joint disease in the Lisfranc joint. Arthrosis in the absence of trauma is less documented but is a common source of midfoot pain. Congenital and acquired deformities can contribute to midfoot or Lisfranc arthrosis. These deformities can occur in isolation or in conjunction. Hallux valgus with a short first ray or hypermobility often lend to first ray insufficiency and transfer peak pressures to the

History

Clinical history of trauma in a variety of forms can result in the tarsometatarsal pain, instability, and dislocation with associated fractures. Low-energy trauma, such as a fall on a stair or from a height, can cause sprains or instability that may initially seem minor in comparison with high-energy injuries. High-energy causes commonly involve motor vehicle accidents or heavy equipment accidents, such as being crushed by a forklift. A tire from a motorized vehicle can apply a large amount of

Arthrodesis

The surgical approach for arthrodesis is the same as for ORIF. Percutaneous techniques during ORIF obviously limit soft tissue injury and the need for open incisions if anatomic reduction can be achieved with a closed reduction. During elective surgery, I commonly approach the first metatarsal cuneiform joint from an incision dorsal and medial to the extensor hallucis long tendon. In isolation, this incision provides excellent exposure to all areas of the joint but does not allow enough

Summary

The Lisfranc joint is a complex joint encompassing 6 articulations, weak dorsal ligaments, and strong plantar ligaments. The Lisfranc ligament serves to secure the second metatarsal in the keystone of the midfoot. Traumatic ligament injury and fracture can result in deformity, instability, pain, and degenerative joint disease of the Lisfranc joint. Increased awareness of Lisfranc joint anatomy and advanced imaging has allowed more accurate diagnosis and treatment of this injured joint complex.

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References (27)

  • G. Peicha et al.

    The anatomy of the joint as a risk factor for Lisfranc dislocation and fracture-dislocation. An anatomical and radiological case control study

    J Bone Joint Surg Br

    (2002)
  • G. Ross et al.

    Plantar ecchymosis sign: a clinical aid to diagnosis of occult Lisfranc tarsometatarsal injuries

    J Orthop Trauma

    (1996)
  • S.M. Raikin et al.

    Prediction of midfoot instability in the subtle Lisfranc injury. Comparison of magnetic resonance imaging with intraoperative findings

    J Bone Joint Surg Am

    (2009)
  • Cited by (13)

    • Pediatric Lisfranc variants and equivalent injuries: A review

      2022, Fuss und Sprunggelenk
      Citation Excerpt :

      The TMT joints encompass the articulations of MT1 with the first cuneiform; of MT2 with the second cuneiform; of MT3 with the third cuneiform; and of MT4 and MT5 with the cuboid. The tibialis anterior, the tibialis posterior, the peroneous longus muscles with their tendon insertions; the extensions of the long plantar ligament; the plantar fascia; and the intrinsic muscles add stability to the foot [14,15]. The ligamentous structures, which maintain stability of the Lisfranc joint complex medially and movement laterally, include the TMT, the intermetatarsal, and the intertarsal ligaments.

    • Classification of the interosseous tarsometatarsal ligaments of the foot

      2022, Foot and Ankle Surgery
      Citation Excerpt :

      The tarsometatarsal ligaments comprise dorsal, plantar, and interosseous layers based on their locations on the foot [6]. The dorsal tarsometatarsal ligaments have been reported to have seven to nine components, and the plantar tarsometatarsal ligaments five to nine components [3,6,7,9,14–19]. The dorsal and plantar tarsometatarsal ligaments have been classified into four and five types, respectively, based on the combinations of the ligamentous components [19,20].

    • Ankle and foot injuries in runners

      2019, Clinical Care of the Runner: Assessment, Biomechanical Principles, and Injury Management
    • MR Imaging of the Midfoot Including Chopart and Lisfranc Joint Complexes

      2017, Magnetic Resonance Imaging Clinics of North America
      Citation Excerpt :

      Hallux valgus, with a short first ray, may result in transfer of peak pressures to the lesser metatarsals, which can cause joint instability, plantar plate tears, stress fractures, and degenerative joint disease of the tarsometatarsal articulations. Flat foot deformity and pes equinus are other conditions that may contribute to the development of midfoot osteoarthrosis (OA).31 Traumatic injuries at the tarsometatarsal joints, or Lisfranc joint complex, may occur in the setting of high-energy and low-energy trauma.

    • Lisfranc injuries

      2015, Injury
      Citation Excerpt :

      Attempting to flex the foot at the Lisfranc joint could demonstrate dorsal subluxation and instability [7]. Applying lateral or medial stress force to the metatarsals helps to predict which joints are unstable [20]. Finally, pain experienced on passive abduction and pronation of the forefoot also suggests a Lisfranc injury [21].

    • Midfoot arthritis: Diagnosis and treatment

      2012, Foot and Ankle Surgery
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