Three-Dimensional Morphometric Analysis of the Lisfranc Joint and Its Relationship to Injury

Background/Objectives: Lisfranc joint injuries are complex midfoot pathologies frequently associated with subtle radiologic findings and delayed diagnosis. Although ligamentous disruption is considered the primary mechanism, the contribution of intrinsic osseous morphology remains insufficiently investigated. Previous studies have primarily relied on two-dimensional measurements and limited morphometric parameters. Therefore, this study aimed to provide a comprehensive three-dimensional (3D) computed tomography (CT) based morphometric evaluation of the medial and central columns of the Lisfranc joint and to determine whether specific bony parameters are associated with injury predisposition. Methods: A total of 48 CT scans, including 23 from patients with Lisfranc joint injuries and 25 from healthy controls without midfoot trauma, were retrospectively analyzed. For both groups, 3D models of the first three metatarsals (M1-M3) and cuneiforms (C1-C3) were reconstructed to measure bone length, articular surface areas, volumes, M1-M2/M2-M3 depth differences, and dorsal step-off (dorsal subluxation of M2 relative to C2). Correlations of these measurements with M2 length were additionally assessed in each group. Results: Comparisons between injury and healthy control groups revealed no significant differences in bony morphometrics (p > 0.05). Correlation analysis showed that a longer M2 were associated with greater cuneiform volumes and larger metatarsal articular surface areas (p < 0.05). Conclusions: This comprehensive 3D morphometric assessment of the Lisfranc joint indicates that intrinsic bony anatomy alone is unlikely to represent a primary predisposing factor for Lisfranc injuries. The observed positive relationship between M2 length and cuneiform articular surface areas and volumes demonstrates structural interdependence within the medial and central columns. Overall, injury susceptibility does not appear to be explained by variations in osseous morphology alone.