In my Houston podiatry practice, I see athletes with Lisfranc injuries, so I’ve already covered that topic extensively on the blog. But today, I want to talk about your TMT joints which we also call tarsometatarsal or Lisfranc joints.

Basically, these are a group of joints that sit in the middle of your foot. They connect your metatarsal and tarsal bones. (These are in your toes and foot arch, respectively.) And, if you injure your TMT joints, you’ll first experience foot pain. Then, if you don’t seek treatment, you could develop arthritis or even a collapsed arch. For that reason, you need to come in right away if there’s a chance you’ve injured your TMT joints. But before we explore how that might happen, let’s take a closer look at the tmt joint foot pain connection. 

What are TMT Joints? Relief for TMT Joints injuries

As I just mentioned, TMT joints connect your tarsal and metatarsal bones. There are five tarsal bones, that together create your foot arch. These are the:

  • Navicular bone
  • Cuboid bone
  • medial, intermediate and lateral cuneiform bones

Your metatarsal bones are numbered one through five.  They connect your tarsal bones to the bones in your toes. And, between the tarsals and metatarsals? That’s where you find your TMT joints.

Common Lisfranc Joint Injuries

Luckily, this American Academy of Orthopedic Surgeons review suggests that it’s pretty rare to injure your TMT joints. But, when they do happen, they could spell big trouble. Most Lisfranc joint injuries happen in one of two ways: you crush your midfoot, or you bend or twist it unnaturally. Often, these injuries happen when you play sports like football. But lots of people hurt their TMT joints in car accidents, or after a fall. When that happens, your bones may break, or you may sustain cartilage damage.

Symptoms of TMT Joint Foot Injury

It’s often hard to tell when you hurt this group of joints. And that’s because your symptoms can look a lot like an ankle sprain. Common symptoms include

  • Pain and swelling on the top of your foot
  • Walking pain
  • Difficulty placing weight on your affected foot
  • Pain when pushing off to walk
  • Bruising near the arch of your foot

If you notice these symptoms, you should stop exercising right away and give your impacted foot a rest. Then, if your symptoms don’t improve, come see me for diagnostic testing. That’s the best way to figure out if your Lisfranc joints are causing your symptoms.

Diagnosis and Treatment 

When you come into my office with TMT joint pain, I’ll conduct a thorough physical exam and medical history. I may have you try to stand on your tiptoes, or I might twist the front of your foot. My goal? To see if the pain you feel is coming from the middle of your foot, which could mean injury to your TMT joints.

In some cases, I’ll use our in-office x-ray machine to get a more complete picture of the scene in your midfoot. This could help me rule out a foot fracture or Jones injury. Then, if I don’t see any signs of fracture on your x-ray, you may need an MRI. That way, I can tell if you’ve sustained any soft tissue damage. And once I know exactly what we’re dealing with, I can come up with a treatment plan that suits your diagnosis.


As always in my practice, I start treating TMT joint foot pain with the least invasive treatment options available. I can use non-invasive treatments if your joint is stable, and you haven’t broken or dislocated your bones or detached your ligament.

In these conditions, I can stabilize your foot and keep weight off your injury, either with a walking boot, cast or crutches. If we choose this treatment option, we’ll monitor your pain and healing for at least 6 weeks before letting you try to bear weight on your injured TMT joints.

After healing, I’ll probably suggest fitting you for a custom orthotic, to help support the joints and bones surrounding your foot arch. In some cases, I may suggest physical therapy to help you regain your balance and restore your healthy gait.

Surgical Intervention Diagnosing TMt joint foot injury with x-ray

If you dislocated your bones, or you seriously damaged your soft tissue or cartilage, I may need to treat your injured TMT joints surgically. (The same is true if less invasive treatments don’t work for your feet.)

When surgery is necessary, I’ll carefully review the nature of your procedure. In some cases, I’ll need to use plates or screws to stabilize your TMT joints or simply bring them back into their correct position. For some injuries to these joints, we may need to fuse the individual bones into a larger, singular bone piece. Either way, after surgery, expect to avoid bearing for up to 8 weeks, usually followed by physical therapy.

No matter the nature of your injury, you have to address pain in your TMT joints right away. That’s because any damage to this important group of joints can lead to painful complications, including foot arthritis.

Now, it can be hard to diagnose injuries in your midfoot, since it contains so many small and complex groups of joints and bones. It can be even harder to heal these injuries, because your mid foot doesn’t get much blood flow. And oxygen-rich blood is a crucial part of the healing process.

Still, with early diagnosis and intervention, we can often manage TMT joint injuries without surgery. But that’s only true if you come in to the office as soon as you notice symptoms, including bruising, walking pain, or difficulty bearing weight on your foot.

Of course, these symptoms could indicate injuries to other parts of your foot or ankle. But here’s the good news. If you have any kind of foot pain, whether or not your TMT joints are affected, it’s very important to get a physical exam. That way, we can rule out fractures or tears of any kind, so you can heal properly. And that’s why I urge you to make an appointment at the first sign of foot pain!


Dr. Andrew Schneider
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A podiatrist and foot surgeon in Houston, TX.