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Topic

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First tarsometatarsal joint

The first tarsometatarsal (TMT) joint is the articulation between the base of the first metatarsal and the medial cuneiform bone. It forms a key component of the medial column of the foot and plays a crucial role in maintaining arch stability and controlled forefoot motion during gait.

It is an important landmark in foot anatomy, biomechanics, orthopedic surgery, and imaging evaluation of midfoot disorders.

Synonyms

  • First TMT joint

  • Medial tarsometatarsal joint

Location

  • Situated in the medial midfoot

  • Between the medial cuneiform and base of the first metatarsal

  • Anterior to the navicular bone

  • Posterior to the first metatarsal shaft

  • Forms part of the Lisfranc joint complex

Anatomical components

  • Articular surfaces:

    • Base of the first metatarsal

    • Distal surface of the medial cuneiform

  • Joint capsule

  • Stabilizing ligaments:

    • Dorsal tarsometatarsal ligament

    • Plantar tarsometatarsal ligament

    • Interosseous ligaments

  • Fibrocartilaginous interface supporting joint congruity

Relations

Anteriorly:

  • First metatarsal shaft

Posteriorly:

  • Medial cuneiform

Medially:

  • Medial column of the foot

Laterally:

  • Second tarsometatarsal joint

Superiorly:

  • Dorsal midfoot soft tissues

Inferiorly:

  • Plantar fascia and intrinsic foot muscles

X-ray appearance

Plain radiographs (AP, oblique, and lateral foot views):

  • Joint space: Narrow, well-aligned articulation between medial cuneiform and first metatarsal base

  • Margins: Smooth and congruent articular surfaces

  • Alignment: First metatarsal aligned with medial cuneiform without step-off

  • Best seen on: AP and oblique views

CT appearance

Non-contrast CT:

  • Joint surfaces: Well-defined cortical margins of medial cuneiform and first metatarsal base

  • Joint space: Uniform and symmetric

  • Trabecular pattern: Normal cancellous bone texture

  • Spatial evaluation: Excellent for assessing joint congruity and subtle cortical irregularities

  • Lisfranc relationship: Clearly demonstrated

MRI appearance

T1-weighted images:

  • Bone marrow: High signal in medial cuneiform and first metatarsal base

  • Cortex: Low signal outlining articular margins

  • Joint space: Low signal with thin cartilage interface

T2-weighted images:

  • Articular cartilage: Intermediate signal

  • Joint fluid: High signal

  • Surrounding ligaments: Low-to-intermediate signal

STIR:

  • Fat suppression: Uniform marrow fat suppression

  • Joint margins: Clearly delineated

  • Capsule and periarticular soft tissues: Bright signal

Proton density fat-saturated (PD FS):

  • Bone marrow: Fat suppressed

  • Joint fluid: High signal

  • Ligaments and capsule: Well visualized as low-signal structures

MRI image

First tarsometatarsal joints mri anatomy labelled image-img-00000-00000

CT VRT 3D image

First tarsometatarsal joints