Tarsometatarsal joint injuries in the athlete

This is a retrospective review of the presentation, diagnosis, treatment, and outcome of 19 patients who injured the tarsometatarsal joint of the foot during athletic activity. Diagnosis by clinical and radiographic examination was supplemented by stress fluoroscopy of the articulation under anesthesia. Injuries were classified as either a first- or second-degree sprain of the tarsometatarsal joint, a third-degree sprain (with diastasis between the metatarsals or cuneiforms), a fracture, or frank dislocation. Poor functional results were seen in those for whom diagnosis was delayed and for whom the injury was not treated adequately. Three patients were unable to return to sports, one of whom eventually required fusion of the tarsometatarsal joint. The third-degree sprains were indistinguishable from fracture and fracture-dislocations in that good results were not reliably obtained by nonoperative treatment, and both classes of injury seem to require open reduction and internal fixation for optimal return to function. The delay in return to full activity is a marker of the severity of this injury despite an often benign appearance on radiograph.