Current management of tarsometatarsal injuries in the athlete

The frequency of foot injuries is increasing in certain athletes, particularly injuries to the tarsometatarsal joint complex. A high index of suspicion for this injury is required to make the diagnosis because the clinical signs often are subtle. A comprehensive examination along with bilateral weight-bearing plain radiographs of the foot should be obtained in any suspected midfoot injury. Further imaging studies and stress radiographs may assist in the diagnosis and direct management. Nonsurgical treatment can be considered in a stable sprain with less than 2 mm of diastasis between the first and second metatarsal bases on a weight-bearing AP foot radiograph. Any tarsometatarsal injury with displacement of more than 2 mm or instability requires surgical treatment. Various techniques and approaches have been described, depending on the injury pattern, including primary arthrodesis and ligament reconstruction. Anatomic reduction is the most critical goal in the treatment of these injuries.