TARSOMETATARSAL JOINT INJURIES IN THE ATHLETE

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