Causes / typical injury mechanism: Tarsometatarsal injuries can be caused by direct or indirect mechanisms. Direct injuries are typically from high-energy blunt trauma or crush injury to the dorsum of the foot. Indirect injuries are caused by a rotational and/or axial force through a plantarflexed foot.

Classic history and presentation: Acute midfoot pain, swelling, and inability to bear weight after a high-energy crush or athletic injury.

Prevalence: Incidence of 1 per 55 000 persons, accounting for 0.2% of all fractures.

• Age – More common in the third decade of life.
• Sex / gender – More common in males.

Risk factors: Certain anatomic variations at the 2nd tarsometatarsal joint may increase risk for a Lisfranc injury.

Pathophysiology: A Lisfranc injury is a ligamentous and/or bony injury to the Lisfranc (tarsometatarsal) joint complex, which is critical to the stability of the midfoot and allows for normal gait. These injuries frequently manifest with widening between the 1st and 2nd metatarsal bases due to their limited ligamentous connections.

Grade / classification system: Multiple classification systems have been described but have limited utility.