Tarsometatarsal joints

Location: Across the middle of the foot, where the bases of the five metatarsals meet the three cuneiforms and the cuboid.

Bones taking part

• Medial cuneiform
• Intermediate cuneiform
• Lateral cuneiform
• Cuboid
• First metatarsal (base)
• Second metatarsal (base)
• Third metatarsal (base)
• Fourth metatarsal (base)
• Fifth metatarsal (base)

Articulating surfaces

• First metatarsal base with the distal surface of the medial cuneiform.
• Second metatarsal base with all three cuneiforms: it sits in a recess, meeting the intermediate cuneiform at its end and the medial and lateral cuneiforms, which project beyond the intermediate, on either side.
• Third metatarsal base with the lateral cuneiform.
• Fourth metatarsal base with the lateral cuneiform and the cuboid.
• Fifth metatarsal base with the cuboid.

Structural

Synovial joints.

Functional

Amphiarthrosis in practice (only slight gliding), although structurally synovial (diarthrosis).

Synovial subtype

Plane.

Axes

Non-axial (gliding).

Capsule & cavity

Usually described as three separate joint cavities: a medial one for the first metatarsal and medial cuneiform; an intermediate one for the second and third metatarsals, continuous with the intercuneiform and cuneonavicular joints; and a lateral one for the fourth and fifth metatarsals with the cuboid. Each capsule is lined by synovial membrane and reinforced by dorsal, plantar and interosseous ligaments.

• Standing: transmit weight from the midfoot to the metatarsals and so to the forefoot.
• Walking: their small gliding lets the forefoot adapt to the ground, while the locked second ray gives a firm lever for push-off.
• Balance: help maintain the transverse arch of the foot formed by the bases of the metatarsals and the distal tarsal row.
• Locomotion: the stable middle forefoot transfers the force of calf muscles to the ground during push-off.

Stability vs mobility: Stability is favoured over mobility. The keystone position of the second metatarsal base, the arched arrangement of the bones and strong dorsal, plantar and interosseous ligaments make the row firm. Only slight gliding is allowed, a little more at the first and at the fourth and fifth joints.

• Lisfranc injury: a fracture-dislocation or ligament injury at the tarsometatarsal joints, often involving the second metatarsal base; it can be missed and may cause long-term foot pain if untreated.
• The tarsometatarsal line is a surgical landmark for amputation through the foot.
• Arthritis of these joints after injury causes midfoot pain on walking.

• Plane synovial joints; slight gliding only.
• Know which tarsal bone each metatarsal meets (1 → medial cuneiform; 2 → all three cuneiforms; 3 → lateral cuneiform; 4 → lateral cuneiform and cuboid; 5 → cuboid).
• Second metatarsal base is recessed (keystone) → most stable.
• Three joint cavities: medial, intermediate, lateral.
• Lisfranc ligament: medial cuneiform to base of second metatarsal.

• Saying the navicular articulates with the metatarsals — it does not; it articulates with the cuneiforms.
• Saying the first metatarsal articulates with the intermediate cuneiform — it articulates with the medial cuneiform.
• Placing dorsiflexion and plantarflexion of the foot here instead of at the ankle joint.
• Calling these joints hinge or condylar — they are plane joints.