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Tarsometatarsal joint injuries in the athlete

Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, Maryland

Mark Myerson, MD

Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, Maryland

Brian Szura, MD

Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, Maryland

This is a retrospective review of the presentation, di agnosis, treatment, and outcome of 19 patients who injured the tarsometatarsal joint of the foot during ath letic activity. Diagnosis by clinical and radiographic ex amination was supplemented by stress fluoroscopy of the articulation under anesthesia. Injuries were classi fied as either a first- or second-degree sprain of the tarsometatarsal joint, a third-degree sprain (with dias tasis between the metatarsals or cuneiforms), a frac ture, 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 reduc tion 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 appear ance on radiograph.

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