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Lisfranc complex

The Lisfranc complex refers to the anatomical and ligamentous structures forming the tarsometatarsal (TMT) joint complex, which connects the midfoot to the forefoot. It includes the osseous articulations and stabilizing ligaments that maintain alignment between the metatarsal bases and the cuneiforms and cuboid.

This complex plays a central role in foot stability, weight transmission, and gait mechanics, and is a critical region in foot trauma and imaging.

Synonyms

  • Lisfranc joint complex

  • Tarsometatarsal joint complex

Location

  • Situated between the midfoot and forefoot

  • Formed by the bases of the metatarsals and distal tarsal bones

  • Extends from the medial cuneiform to the cuboid

  • Oriented transversely across the midfoot

  • Separates the hindfoot and midfoot from the forefoot

Anatomical components

  • Osseous elements:

    • First, second, and third cuneiforms

    • Cuboid

    • Bases of the first through fifth metatarsals

  • Articular configuration:

    • Second metatarsal base recessed between medial and lateral cuneiforms (“keystone”)

  • Ligamentous elements:

    • Dorsal tarsometatarsal ligaments

    • Plantar tarsometatarsal ligaments

    • Lisfranc ligament (interosseous ligament): medial cuneiform to base of second metatarsal

Relations

Anteriorly:

  • Metatarsal shafts

Posteriorly:

  • Cuneiforms and cuboid

Medially:

  • Medial cuneiform and first metatarsal base

Laterally:

  • Cuboid and fourth/fifth metatarsal bases

Superiorly:

  • Dorsal midfoot soft tissues and extensor tendons

Inferiorly:

  • Plantar fascia and intrinsic foot muscles

X-ray appearance

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

  • Alignment: Bases of metatarsals align with corresponding tarsal bones

  • Second metatarsal: Normally aligned with the intermediate cuneiform

  • Joint spaces: Uniform and symmetric

  • Medial border of 2nd metatarsal: In line with medial border of intermediate cuneiform

CT appearance

Non-contrast CT:

  • Osseous detail: Excellent visualization of tarsometatarsal articulations

  • Joint congruity: Clearly defined

  • Second metatarsal “keystone”: Well seated between cuneiforms

  • Subtle cortical offsets: Easily appreciated

  • Useful for: Detailed assessment of joint morphology and alignment

MRI appearance

T1-weighted images:

  • Bone marrow: High signal in metatarsal bases and tarsal bones

  • Ligaments: Low-signal linear structures

  • Lisfranc ligament: Seen as a low-signal band between medial cuneiform and second metatarsal base

T2-weighted images:

  • Joint spaces: High-signal fluid if present

  • Ligaments: Low signal

  • Articular cartilage: Intermediate signal

STIR:

  • Fat suppression: Uniform marrow fat suppression

  • Joint and soft tissues: High signal fluid

  • Ligament margins: Clearly outlined

Proton density fat-saturated (PD FS):

  • Ligaments: Well delineated as low-signal bands

  • Joint spaces: Bright signal

MRI image

Lisfranc complex mri anatomy labelled image-img-00000-00000

MRI image

Lisfranc complex mri anatomy labelled image-img-00000-00000_00001

X Ray image

Lisfranc complex