Topics

Topic

design image
First dorsal cuneometatarsal ligament (Dorsal lisfranc ligament)

The first dorsal cuneometatarsal ligament (commonly called the dorsal Lisfranc ligament) is a thin but important stabilizer of the medial Lisfranc joint complex. It spans the dorsal medial cuneiform to the dorsal base of the second metatarsal, superficial to the interosseous Lisfranc (proper) ligament. Although weaker than the interosseous and plantar components, it helps restrain dorsal displacement and diastasis at the medial tarsometatarsal junction.

Synonyms

  • Dorsal Lisfranc ligament

  • Dorsal medial cuneiform–second metatarsal ligament

  • Dorsal first cuneometatarsal ligament (to 2nd met base)

Origin, Course, and Insertion

  • Origin: Dorsal surface of the medial cuneiform

  • Course: Runs obliquely laterally across the dorsal Lisfranc joint, superficial to the joint capsule

  • Insertion: Dorsal base of the second metatarsal

Relations

  • Superiorly: Dorsal fascia; extensor tendons (EHL/EDL) crossing the midfoot

  • Inferiorly: First–second tarsometatarsal joint capsule and joint space

  • Medially: Medial cuneiform; dorsal medial capsular fibers

  • Laterally: Base of the second metatarsal and adjacent dorsal cuneometatarsal ligaments

  • Deep: Interosseous (Lisfranc) ligament (medial cuneiform → base of 2nd MT)

  • Anterior/Posterior: Dorsal aspects of 2nd MT base and medial cuneiform, respectively

Function

  • Dorsal restraint: Limits dorsal translation of the second metatarsal relative to the medial cuneiform

  • Diastasis control: Helps resist MC–2MT diastasis with the interosseous and plantar ligaments

  • Arch support: Contributes to medial column stability and preservation of the longitudinal arch during push-off

  • Load sharing: Assists transfer of forces between midfoot and forefoot in gait

Clinical Significance

  • Lisfranc injury pattern: Frequently sprained or torn in plantarflexion + axial load/twist mechanisms (sports, falls)

  • Instability signs: MC–2MT widening (>2 mm), dorsal subluxation; “fleck sign” avulsion fragment at 2nd MT base or medial cuneiform on CT/radiographs

  • Symptoms: Midfoot pain/swelling, plantar ecchymosis, difficulty weight-bearing, tenderness over Lisfranc joint

  • Consequences: Missed injury → chronic instability, arch collapse, post-traumatic arthritis

  • Imaging role: MRI best for ligament integrity/edema; CT best for alignment, subtle fractures, and fleck sign

Nerve Supply

  • Articular branches from the deep fibular (peroneal) nerve and medial plantar nerve to the dorsal tarsometatarsal region

MRI Appearance

  • T1-weighted:

    • Normal: thin, low-signal (dark) band from medial cuneiform to 2nd MT base

    • Partial tear: thickening, waviness, or focal discontinuity with intermediate signal

    • Complete tear: loss of continuous low-signal band; possible retraction; adjacent marrow T1 intermediate changes at attachments

  • T2-weighted:

    • Normal: low signal ligament; surrounding joint fluid brighter for contrast

    • Partial/complete tear: hyperintense gap or fraying along the ligament; T2 marrow edema at MC and/or 2MT base common

    • Alignment clue: subtle dorsal step-off of 2MT base may be appreciated on sagittal/oblique planes

  • STIR:

    • Normal: dark linear band

    • Injury: bright periligamentous edema, capsular fluid, and bone marrow edema at attachment sites

  • PD Fat-Sat:

    • Normal: crisp dark band; helps track oblique course

    • Tear: bright signal within or replacing band; delineates partial vs complete fiber disruption

    • Associated: capsular sprain, joint effusion, periosteal edema, and adjacent ligament injuries (plantar/ interosseous)

  • T1 Fat-Sat Post-Contrast:

    • Normal: minimal or no enhancement

    • Acute/chronic sprain: enhancing torn margins and periligamentous soft tissues (granulation/synovitis)

    • Helpful in equivocal partial tears and chronic pain workups

CT Appearance

  • Non-contrast CT:

    • Ligament not directly seen; evaluate bony alignment of medial cuneiform and base of 2nd MT

    • Fleck sign: tiny avulsion fragment between MC and 2MT base is highly suggestive of Lisfranc injury

    • Diastasis: MC–2MT gap >2 mm or asymmetry vs contralateral foot; dorsal subluxation on sagittal planes

    • Secondary findings: subtle cortical avulsions, impaction at 2MT base, subchondral sclerosis in chronic cases

  • Post-contrast CT (standard):

    • Soft-tissue enhancement may outline capsular inflammation/hematoma but adds little over non-contrast for ligament fibers

    • Best use remains fracture mapping and joint incongruity assessment

MRI image

First dorsal cuneometatarsal ligament (Dorsal Lisfranc Ligament) axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000

MRI image

First dorsal cuneometatarsal ligament (Dorsal Lisfranc Ligament) coronall cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000

MRI image

First dorsal cuneometatarsal ligament (Dorsal Lisfranc Ligament) coronall cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000_00001