The point at which the metatarsal bones (long bones that lead up to the toes) and the tarsal bones (bones in the arch) connect is the linchpin for foot joint strength and each person’s ability to balance. Increasingly, this juncture in the foot, which is connected by a tough band of tissue otherwise known as the Lisfranc ligament, is being viewed as THE key to joint changes.
Let’s Take a Closer Look at the Lisfranc Joint Complex
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Secondary#arthritis#lisfrancjointcomplex#morphology
However, a new study of the morphology of this important joint complex, found significant variability in the form of the plantar Lisfranc ligament. Why?
The study, “Morphology of the Lisfranc joint complex,” was published online on July 24,2022 in The Journal of Foot and Ankle Surgery.
The researchers wrote, “Lisfranc injuries are complicated injuries of the tarsometatarsal joint with high rates of sequelae.”
They explained that the descriptions of these injuries and their associated structures can vary greatly. In their analysis, they found that the most injured structures are those of the Lisfranc joint complex, which involved the medial cuneiform, second and third metatarsals, and the dorsals, interosseous, and plantar Lisfranc ligaments.
For their analysis, they dissected 22 embalmed cadaveric feet (13 male, 9 female, 80.3 years ± 14.03). The dorsal, interosseous, and plantar Lisfranc ligaments were measured, and their morphology noted.
The dissected dorsal Lisfranc ligament had a consistent morphology (mean = 10.8 mm ± 1.79). The interosseous Lisfranc ligament had a consistent path, but 11 of the 17 ligaments had a connection to the plantar Lisfranc ligament.
There was a wide variability in the form of the plantar Lisfranc ligament, the researchers noted. It had a Y-variant in three of the specimens and a fan-shaped variant in 14 of the specimens. Ligament thickness was greatest in the interosseous Lisfranc ligament (mean = 13.74 ± 3.08) and least in the dorsal Lisfranc ligament (mean = 1.36 ± 0.42).
“While the objective of defining joint and ligament morphology was achieved, further questions were raised,” the researchers wrote.
Study authors included Meridith K. DeLuca, M.S., and Laura C. Boucher, Ph.D., ATC., of The Ohio State University College of Medicine.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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