Topics

Topic

design image
Tarsometatarsal joints

The tarsometatarsal joints (TMT joints), also known as the Lisfranc joints, form the articulations between the distal row of tarsal bones and the bases of the metatarsals. They are essential for maintaining midfoot stability and arch integrity, transmitting forces between the hindfoot and forefoot during walking and running.

These joints collectively form a transverse arch across the midfoot and are reinforced by strong ligamentous and capsular structures. The second TMT joint, which interlocks with the intermediate cuneiform, serves as a keystone for midfoot stability. The complex arrangement allows limited gliding motion but provides strong resistance against shearing forces.

Injury to the TMT joints—especially Lisfranc injuries—can result in significant midfoot instability and long-term disability if not accurately diagnosed and treated.

Synonyms

  • Lisfranc joint complex

  • Tarsometatarsal articulation

  • Midfoot joints

Components and Articulations

  • Medial articulation: Between the first metatarsal and the medial cuneiform

  • Intermediate articulation: Between the second metatarsal and the intermediate cuneiform

  • Lateral articulations: Between the third metatarsal and lateral cuneiform, and between the fourth and fifth metatarsals with the cuboid

  • The second metatarsal base projects proximally between the medial and lateral cuneiforms, providing a locking mechanism for midfoot stability

Ligamentous Support

  • Dorsal tarsometatarsal ligaments: Connect tarsal bones to metatarsal bases on the dorsal surface

  • Plantar tarsometatarsal ligaments: Stronger than dorsal ligaments; reinforce the plantar aspect of the joints

  • Interosseous (Lisfranc) ligament: Connects the base of the second metatarsal to the medial cuneiform; the key stabilizing structure of the Lisfranc joint complex

Relations

  • Superiorly: Dorsal tendons of the extensor hallucis longus and extensor digitorum longus muscles

  • Inferiorly: Plantar aponeurosis and flexor tendons of the foot

  • Medially: Medial cuneiform and first metatarsal base

  • Laterally: Cuboid and fifth metatarsal articulation

  • Posteriorly: Naviculocuneiform joint complex

Nerve Supply

  • Deep fibular (peroneal) nerve (dorsally)

  • Medial and lateral plantar nerves (plantar aspect)

Function

  • Load transmission: Transfers forces from the hindfoot to the forefoot during locomotion

  • Arch stabilization: Maintains transverse and longitudinal arches of the foot

  • Flexibility: Allows limited gliding motion for shock absorption

  • Stability: The second metatarsal “keystone” restricts excessive movement, ensuring midfoot rigidity

  • Dynamic role: Essential for propulsion and weight-bearing during gait

Clinical Significance

  • Lisfranc injury: Disruption of the tarsometatarsal joint complex, commonly from axial load or twisting injuries

  • Fracture-dislocation: May involve metatarsal bases and cuneiforms

  • Arthritis: Degenerative changes or post-traumatic arthritis can cause midfoot pain and stiffness

  • Inflammation: Seen in rheumatoid arthritis or gout affecting midfoot joints

  • Imaging relevance: Early MRI and CT evaluation critical for accurate diagnosis of subtle injuries

MRI Appearance

  • T1-weighted images:

    • Normal: articular cartilage appears intermediate to low signal, cortical bone dark, subchondral marrow intermediate

    • Ligaments (dorsal, plantar, interosseous): low signal (dark linear bands)

    • In Lisfranc injury: discontinuity or high-signal gap in interosseous ligament and marrow edema at metatarsal bases or cuneiforms

  • T2-weighted images:

    • Normal: cartilage intermediate signal, joint space bright from small physiologic fluid

    • Injuries: hyperintense signal in ligament tears or edema within bone and surrounding soft tissues

    • Joint effusion and marrow edema become more conspicuous

  • STIR:

    • Normal: dark cortical outlines, faint joint fluid

    • Pathology: bright signal in ligament disruptions, soft tissue edema, or bone contusion

  • Proton Density Fat-Saturated (PD FS):

    • Normal ligaments: dark continuous bands

    • Tears: bright discontinuous signals across Lisfranc ligament or interosseous planes

    • Useful for subtle partial ligamentous injuries and early marrow changes

  • T1 Fat-Sat Post-Contrast:

    • Normal: minimal enhancement of capsular tissues

    • Injuries: enhancing periligamentous tissues or synovitis

    • Chronic degeneration shows mild diffuse enhancement

CT Appearance

Non-Contrast CT:

  • Provides excellent delineation of osseous structures

  • Normal findings: Smooth cortical margins, congruent joint alignments

  • Lisfranc injuries: Widening between first and second metatarsal bases (>2 mm), step-offs at joint surfaces, or small avulsion fragments (“fleck sign”)

  • Chronic degeneration: Subchondral sclerosis, osteophyte formation, and joint space narrowing

Post-Contrast CT (standard):

  • Contrast enhances surrounding soft tissues but not cartilage

  • Useful for detecting associated synovial thickening or subtle inflammatory changes in arthritis

MRI image

Tarsometatarsal joints coronal cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000

MRI image

Tarsometatarsal joints coronal cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000_00001

MRI image

Tarsometatarsal joints coronal cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000_00002

CT VRT 3D image

Tarsometatarsal joints ct 3d image

X Ray image

Tarsometatarsal joints (Lisfranc’s joint) 1