The tarsometatarsal (TMT) joints, also known as Lisfranc joints, are complex joints in the middle of the foot. These joints connect the tarsal bones to the metatarsal bones. The tarsal bones form the arch of the foot, while the metatarsal bones connect the tarsal bones to the toe bones.
TMT joint pain may indicate an injury to the TMT joints. Such injuries are rare but potentially serious. Without treatment, they may lead to arthritis or cause the arch of the foot to collapse.
This article describes what the TMT joints are and looks at some of the more common injuries associated with this part of the foot. It also explains how doctors diagnose and treat these injuries.
The TMT joints are the connections between the tarsals and the metatarsals in the middle of the foot.
Tarsals is the collective name for the five bones that form the arch of the foot. These bones are:
- the navicular
- the cuboid
- the cuneiforms, of which there are three:
Metatarsals is a collective name for another five bones that connect the tarsals to the phalanges, which are the bones in the toes.
The American Academy of Orthopaedic Surgeons (AAOS) explains that the bones, joints, and ligaments of the midfoot help keep the arch of the foot stable. In walking or running, the midfoot transfers the forces that the calf muscles generate to the front of the foot.
Some people refer to TMT joints as Lisfranc joints, with this name coming from the Napoleonic army surgeon Jacques Lisfranc de St. Martin.
According to a 2017 review article, TMT joint injuries are relatively rare, accounting for only 0.2% of all fractures and affecting about 1 in 55,000 people every year.
A separate 2016 review article states that TMT joint injuries can be the result of direct trauma, such as bending or twisting in the midfoot, or indirect trauma, such as crush injuries that also damage the soft tissues. Twisting injuries can result from athletic injuries or something as simple as stumbling.
The article notes that 67% of TMT joint injuries are high velocity injuries associated with motor vehicle accidents. Most of the remaining injuries are from falls or crushing injuries.
The AAOS states that TMT joint injuries include bone fractures and torn ligaments. These injuries can be simple, affecting only one joint, or complex, involving multiple joints, bones, or ligaments. The organization adds that TMT injuries often affect the cartilage, which is the firm but flexible connective tissue between bones. Cartilage allows the joints to move smoothly. Untreated cartilage damage can lead to arthritis.
- swelling, particularly on the top of the foot
- pain when walking, usually when pushing off with the affected foot
- pain when standing or placing weight on the affected foot
- bruising or other discoloration on both the top and bottom of the foot, with bruising beneath the arch of the foot being a particularly good indicator of TMT joint injury
The American Podiatric Medical Association recommends rest as a first-line treatment for foot and ankle joint injuries. The acronym RICE can help people remember what to do in the event of such injuries. RICE stands for:
- Rest: Avoid bearing weight on the injured foot and doing any physical activity that causes or exacerbates symptoms.
- Ice: Apply a cold compress to the area for 15–20 minutes every 3–4 hours for the first 48 hours after injury to reduce swelling and pain.
- Compression: Wrap an elasticated bandage around the affected foot to alleviate swelling.
- Elevation: Use pillows to raise the affected foot to minimize swelling.
The AAOS states that if RICE treatment does not reduce the pain or swelling, it is time to seek medical help.
When diagnosing the cause of TMT joint pain, a doctor will begin by conducting a physical examination of the foot. They will examine the foot for signs of bruising, particularly on the sole. They may also apply pressure to the midfoot to see whether it is tender.
The AAOS states that doctors may also grip the heel and twist the front of the foot or ask a person to stand on tiptoes on the affected foot. If either test causes any pain in the midfoot area, this indicates TMT joint damage.
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The treatment options for TMT joint pain vary depending on the type and extent of the injury.
The AAOS states that doctors may suggest nonsurgical treatment for TMT joint injuries with the following features:
- a stable TMT joint
- no dislocated or broken bones
- attachment of all ligaments
The organization stresses the importance of not bearing weight on the injured foot for 6 weeks. A person will also need to wear a cast or boot to stabilize the foot. Doctors will repeat X-rays to check how the foot is healing.
Once a person can bear weight on the foot, doctors may recommend a full-length arch support orthotic. They may also recommend a course of physical therapy that focuses on improving balance and gait. Even with these measures in place, a full recovery may take 4–6 months.
According to a 2016 review article, surgery may be necessary in cases involving the following:
- bone dislocation or fracture
- significant soft tissue injury
- ineffective nonsurgical treatments
Surgery may involve techniques such as open reduction internal fixation (ORIF) and fusion. ORIF involves using plates or screws to reposition bones correctly and stabilize them. Fusion involves fusing the damaged bones into a single, solid piece. Following either surgery, a person must avoid bearing weight on the foot for about 6–8 weeks.
The tarsometatarsal joint is a complex joint in the midfoot that attaches the tarsal bones to the metatarsal bones. TMT joint pain can be a sign of injury. Without treatment, certain TMT injuries may result in arthritis.
TMT joint injuries can be difficult to diagnose. When diagnosing such injuries, a doctor will carry out a physical examination of the foot. They may also order imaging tests to check for injuries to the bones, joints, and soft tissues.
Nonsurgical treatment options include immobilizing the foot in a boot or cast and avoiding bearing weight on the affected foot. If the bones are broken or dislocated or the ligaments have torn, doctors may recommend surgery to stabilize the joint.