Tarsometatarsal joints

The tarsometatarsal joints are arthrodial joints, often termed as a single joint, the Lisfranc's joint (see below for the different use of the eponym "Lisfranc"). The bones entering into their formation are the first, second, and third cuneiforms, and the cuboid, which articulate with the bases of the metatarsal bones. The first metatarsal bone articulates with the first cuneiform; the second is deeply wedged in between the first and third cuneiforms articulating by its base with the second cuneiform; the third articulates with the third cuneiform; the fourth, with the cuboid and third cuneiform; and the fifth, with the cuboid. The bones are connected by dorsal, plantar, and interosseous ligaments. The ligaments are :

• Dorsal tarsometatarsal ligaments

• Plantar tarsometatarsal ligaments

• Cuneometatarsal interosseous ligaments

The synovial membrane between the first cuneiform and the first metatarsal forms a distinct sac. The synovial membrane between the second and third cuneiforms behind, and the second and third metatarsal bones in front, is part of the great tarsal synovial membrane. Two prolongations are sent forward from it, one between the adjacent sides of the second and third, and another between those of the third and fourth metatarsal bones. The synovial membrane between the cuboid and the fourth and fifth metatarsal bones forms a distinct sac. From it a prolongation is sent forward between the fourth and fifth metatarsal bones.

Movements.—The movements permitted between the tarsal and metatarsal bones are limited to slight gliding of the bones upon each other.

Nerve Supply.—The intertarsal and tarsometatarsal joints are supplied by the deep peroneal nerve.

Terminology of "Lisfranc" joint and ligaments:

• The Lisfranc's joint refers to the tarsometatarsal articulation of the midfoot, specifically involving the bases of the first through fifth metatarsals and their articulation with the three cuneiforms (medial, intermediate, lateral) and the cuboid. The most clinically significant component is the articulation between the medial cuneiform and the base of the second metatarsal, which is stabilized by the Lisfranc ligament complex.

• The Lisfranc's joint complex refers to the complex polyarticular system with an intricate anatomic configuration of skeletal and nonskeletal elements of the tarsometatarsal joints. The skeletal elements are composed of the tarsometatarsal, intertarsal, and intermetatarsal articular surfaces specifically involving the junction between the first, second, and third metatarsal bases and the medial, intermediate, and lateral cuneiforms, as well as the cuboid. The nonskeletal elements (Lisfranc ligamentous complex) comprise the articular capsules, the various ligaments, the prolongations of the long plantar ligament (inferior calcaneocuboid ligament), and the tendons and expansions of the tibialis posterior, tibialis anterior, and peroneus longus, which all function to maintain the stability of the TMT joints

• The Lisfranc ligamentous complex consists of three main ligamentous structures:

  • The dorsal tarsometatarsal ligament ("dorsal Lisfranc's ligament") between the medial cuneiform (C1) to the base of the second metatarsal (M2), weakest part of the complex. As there are more than nine dorsal tarsometatarsal ligaments with a lot of variation, we cannot say if the Dorsal Lisfranc's ligament is the first, second or third dorsal tarsometatarsal ligament. It's better to use the formula dCn1-M2.

  • The first cuneometatarsal interosseous ligament ("Lisfranc ligament proper"), iCn1-M2

  • The second plantar tarsometatarsal ligament (“plantar Lisfranc’s ligament”): variable bundles between tarsus and the second and third metatarsal bases pC1-M2,3