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2Principles

TMT Ligaments

Anatomy and mechanics

The Lisfranc / tarsometatarsal (TMT) articulation is very strong. The base of the second metatarsal is held in place by the plantar TMT ligaments.
The significance is that motion at the base of the second metatarsal is restricted. This leads to fractures at the base of the second metatarsal. Unlike other areas with their “essential” joints, the midfoot area joints are not “essential” and therefore motion can be sacrificed to obtain stability and function. The 1, 2 and 3 TMT joints can in fact be fused for acute purely ligamentous injuries. The 4 and 5 TMT joints should be stabilized with K-wires as some retained motion in this area is helpful for better function, because normally there is motion between the 4th and 5th metatarsal and the cuboid.
As a result, when treating fractures in the Lisfranc / midfoot area, joint surface reconstruction may not be as critical as in other joints.