Longitudinal Lisfranc Injury


Most Lisfranc or tarsometatarsal (TMT) joint injuries result from a horizontally directed force in which
the metatarsals are displaced relative to the midfoot. The injury pattern that is described in this article
is one of a longitudinal force through the first ray and cuneiform. A reliable measure to recognize
the longitudinal Lisfranc variant injury has been the height difference between the distal articular
surfaces of the first and second cuneiform bones in an anteroposterior (AP) weight-bearing radiograph.
This measure helps identify subtle injuries in which there is a proximal and medial subluxation of
the first cuneiform-metatarsal complex. Delayed diagnosis and treatment have been associated with
poorer results and significant functional consequences. This article describes a simple radiographic
measurement to recognize the longitudinal injury pattern and to aid in determining whether operative
intervention is required. (Journal of Surgical Orthopaedic Advances 23(4):233–236, 2014)
Key words: Lisfranc classification, longitudinal Lisfranc variant injury, midfoot radiographic evaluation,
midfoot sprain

Nikhil R. Oak, MD; Arthur Manoli II, MD; and James R. Holmes, MD