The anatomy of the tarsometatarsal joint is quite complex. It consists of the articulations of multiple bones (the five metatarsals, the three cuneiforms and the cuboid bone). Injuries to the tarsometatarsal joints are quite common. These occur in athletics from minor twisting injuries when stepping unevenly to more violent injuries that may occur in motor vehicle accidents or falls.
Historically it is of some interest that the injury used to occur commonly in the cavalry in the Napoleonic era. In those days, the foot was violently wrenched in the stirrup and the only way that this could be treated at that time was by partial amputation of the foot by the renowned surgeon of Napoleon, Lisfranc. The term Lisfranc injury has stuck, although fortunately, treatment by amputation is almost never required.
Symptoms of tarsometatarsal injuries include:
• Inability to bear weight
An orthopedic surgeon will perform a physical exam of the foot and ankle to diagnose a tarsometatarsal injury. Injuries of the tarsometatarsal joint can be quite subtle and are not always easy to see on X-ray. CT scans or MRIs may be needed to help confirm diagnosis of Lisfranc injuries.
Surgery is required for the majority of tarsometatarsal injuries. The treatment of tarsometatarsal injuries is usually done by reduction of the fracture or dislocation by means of screws that are inserted internally into the bones across the joints. The screws are typically left in for approximately four to five months following the surgery. Often after this time they are removed.
There is no cast after the surgery. No walking on the foot is permitted for about six weeks and then walking is initiated with a removable boot. Swimming and biking are permitted early on. Walking in the boot is gradually discontinued at about ten weeks.
If untreated, a fracture or dislocation of the tarsometatarsal joint will often lead to painful arthritis that requires treatment. Arthritis is common if the joints are not carefully lined up and held with screws. If arthritis does occur, then these joints need to be fused.