Etiology and Biomechanics of Midfoot (Lisfranc) Injuries in Athletes.

Tarsometatarsal (TMT) dislocations are an uncommon but debilitating athletic injury. When symptomatic midfoot instability persists, an injured athlete frequently requires surgical stabilization and rehabilitation for up to 9 months before returning to full athletic participation. Unfortunately, the limited biomechanical knowledge of this injury prevents prophylactic measures from being developed that could reduce an athlete's risk of injury. The goal of this article is to summarize the literature on TMT dislocations, with a particular emphasis on the relevant biomechanics, in an attempt to clarify the circumstances and mechanisms under which these injuries occur. Since athletic injuries represent only a small portion of all TMT dislocations, other categories of injuries are also considered for the insight they provide. This review first summarizes the anatomy of the TMT joint as well as the clinical details surrounding TMT dislocations. The various hypothesized injury mechanisms are then reviewed with particular attention given to cadaveric studies that investigate these mechanisms. Based on this critical review, gaps in the research related to epidemiologic data, full-scale and component testing, numerical modeling, and countermeasure development, are identified. Only by improving our understanding of the causes and biomechanics can steps be taken to protect athletes from these injuries.