Joints
Tarsometatarsal joints, Lisfranc line (artt. tarsometatarsales)
The row of joints between the three cuneiforms and the cuboid on one side and the five metatarsals on the other. The second ray is recessed into a notch between the cuneiforms and so forms the keystone of the transverse arch: that recess makes the row both sturdy and vulnerable.
- Joint type
- Plane joints (artt. planae), amphiarthroses with very little excursion
- Latin name
- Articulationes tarsometatarsales
Movements, axes and normal values
| Movement | Plane | Axis | Normal range | End feel |
|---|---|---|---|---|
| Forefoot supination | combined | oblique axis through the length of the foot | a few degrees; the first and fifth rays move most, the second barely at all | firm springy (ligament) |
| Forefoot pronation | combined | oblique axis through the length of the foot | a few degrees, together with the intermetatarsal joints | firm springy (ligament) |
- Close-packed position
- Full forefoot supination
- Resting (loose-packed) position
- Neutral forefoot position
- Capsular pattern
- No clear pattern; end-range pain on twisting the forefoot.
- Arthrokinematics
- Mainly gliding, each ray with its own direction. The first ray moves dorsally and plantarly and contributes to the windlass mechanism; the lateral rays give way so the foot adapts to the ground. Together they set how high the transverse arch stays under load.
- Stability
- The dorsal, plantar and interosseous tarsometatarsal ligaments, with the Lisfranc ligament between the medial cuneiform and the base of the second metatarsal as the key.
- Palpation
- Follow the first metatarsal proximally until you feel a transverse step: that is the first tarsometatarsal joint line. From there the line runs obliquely laterally, with the second ray sitting about half a centimetre further proximally.
- Clinical
- Lisfranc injury: a fracture-dislocation across this line, classically from a fall onto the plantarflexed foot or a blow from above. Recognised by plantar bruising and pain on pronation with forefoot abduction. On a non-weightbearing film the displacement is often invisible, so ask for a weightbearing view when suspected.
- Source
- Speciële anatomie van het houdings- en bewegingsapparaat (HU, 2013); BOKS anatomie WSH (HU, 2025)