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Musculoskeletal system
Published in David A Lisle, Imaging for Students, 2012
Any of the tarsal bones may be fractured. With major trauma, dislocation of intertarsal or tarsometatarsal joints may occur. Lisfranc fracture/dislocation refers to disruption of the Lisfranc ligament, with midfoot instability. Lisfranc ligament joins the distal lateral surface of the medial cuneiform to the base of the second metatarsal, and is a major stabilizer of the midfoot. Radiographic signs of Lisfranc ligament disruption may be difficult to appreciate, and include widening of the space between the bases of the first and second metatarsals and associated fractures of metatarsals, cuneiforms and other tarsal bones (Fig. 8.50). CT or MRI may be required to confirm the diagnosis.
Case Study: The Conservative Management of a Complex Mid Foot Injury in an Elite Professional Footballer
Published in Research in Sports Medicine, 2021
David Rhodes, Mark Leather, Russell Parker
Knowledge of the anatomy of the Lisfranc complex is essential to understanding the clinical, imaging and biomechanical features of an acute Lisfranc injury (LFI) (Mulcahy, 2018; Palastanga et al., 2006). The tarsometatarsal joint (TMTJ) capsules and the ligaments make up an interlaced framework surrounding the Lisfranc joint. Each set of ligaments consists of fibres which run longitudinal, oblique and transversely, which may give reason regarding inconsistency in the orthopaedic and radiological literature (Castro et al., 2010; Hatem, 2008). The dorsal and plantar ligament systems are reinforced by intertarsal and intermetatarsal ligaments and generally the plantar ligament system is stronger than the dorsal ligament system, hence why dorsal dislocations are more common (Mulcahy, 2018; De Orio et al., 2009; Palastanga et al., 2006). The interosseous Lisfranc ligament runs obliquely from the base of the second metatarsal to the medial cuneiform with its importance highlighted because no ligament connects the base of first and second metatarsals (Arastu & Buckley, 2012). The plantar surface has a certain degree of stability primarily due to its various ligaments however this is further reinforced, especially medially, by the insertion of muscles. Slips from tibialis posterior and anterior tendon reinforce the joints of the medial three metatarsals (Palastanga et al., 2006).