0:00

The next layer of joints is gonna be the

0:03

tarsal metatarsal joints.

0:04

So it's a very important joint.

0:06

Um, what we're seeing is the first, second, third,

0:10

fourth, and fifth tarsal metatarsal joints.

0:14

Now, the first

0:17

metatarsal should line up with the first QA form.

0:19

And when we say line up, we're pretty strict about that

0:22

for the, um, for the TMT joints.

0:25

So think of these four bones as, uh, bones

0:28

that really should be locked together very tight.

0:30

This sort of holds in the whole forefoot.

0:33

Uh, you have two lined up with the second, uh, q

0:37

and A form, so you really wanna be strict.

0:39

You don't wanna see any step offs here.

0:41

And the, of course, the, the main ligament that you want

0:44

to be able to identify

0:45

and they're gonna be asked to, um,

0:48

evaluate is the Liz Frank Liga.

0:49

Now, of course, there's ligaments that are going between,

0:52

uh, the, all of the base of the metatarsal,

0:54

but the one that's very important is the Liz Frank Ligament

0:56

proper, which is he has shown here.

0:59

And you can see that there's a diagonally shaped

1:01

hyperintense structure going from the base of the second

1:05

to the medial C form.

1:08

And yes, it does have different parts, the dorsal part,

1:11

the um, interosseous and the plantar.

1:15

But when you're on the long axis,

1:18

this I think is the best view

1:20

to really get a nice look at the Liz Frank Ligament.

1:22

You should look straight, very taut in appearance.

1:26

Um, can have a little bit of striation, that's okay.

1:29

But in a Liz Frank injury, uh, you might have of course,

1:33

rupture of the ligament.

1:34

You might have edema surrounding the ligament,

1:37

and also look for bone marrow edema

1:38

around this site as well.

1:40

So one of my big search patterns is just looking at these

1:43

four bones, again, making sure that one lines up with one,

1:46

two lines up with two, and the Liz Frank ligament is intact.

1:49

We can also look at the Liz Frank Ligament on

1:52

the short axis.

1:53

So we'll scroll through that. And

1:58

I'm also going to

2:05

Keep the chat option open just to make sure that I can still

2:09

answer questions in a bit.

2:11

What you're seeing here on the short axis is, um,

2:13

as we go all the way to the same area,

2:16

it becomes a little bit more confusing.

2:18

What bones are we actually looking at?

2:20

Um, and what you can do is just remember

2:23

that you have the tus, the calcaneus.

2:26

As you go distally, you're gonna be able

2:29

to see the Liz Frank Ligament here.

2:31

This is an interosseous portion.

2:33

You're gonna have a dorsal band, the planter band.

2:36

Also, you can sometimes see as well, um, being over here

2:41

that a plantar band can go to the third metatarsal base.

2:44

But, um, stressing again, I think the,

2:47

the long axis is really your best bet

2:50

to find the Liz Frank Ligament.

2:51

And it's shown right here.

2:53

So, um, remember

2:56

that we do talk about the Liz Franklin a lot,

2:59

but again, there's other things that will keep those bones,

3:02

uh, first on first and second on second as well.

3:05

So for example, you have the capsule of the first TMT joint,

3:08

so I always wanna check that that is intact,

3:10

as you can see here, right?

3:13

Um, and um, again, I check for bone marrow edema

3:17

around these sites.

3:19

If you have an X-ray with a possible bone fragment,

3:22

then actually CT might be better to, um, able

3:26

to see those small little avulsion fracture fragments if the

3:29

Liz Frank Ligament pulled off a bit

3:30

of bone from either side.

3:33

So that is, um,

3:36

a little bit about the Liz Frank ligament to start.

3:39

Um, when you come over here to the, uh, oid, you can see

3:43

that the oid, uh, is a large,

3:46

larger than than just one metatarsal.

3:48

It actually connects to the fourth

3:50

and the fifth, um, metatarsal.

3:53

So the fourth and fifth

3:55

TMT joint is basically the cuboid to both of those.

3:58

And, um, what you're gonna see is

4:00

that there's actually some important structures

4:02

that will attach to the base of the fifth.

4:04

So the base of the fifth, right? A very important thing.

4:08

We're always looking for fractures at the base of the fifth.

4:11

If the fracture is a small little avulsion fracture off the

4:14

tip, um, that would be, um, less

4:17

of a significant than if it's more of a Jones fracture,

4:20

which is sort of just a regular, uh, shaft fracture of the,

4:24

uh, fifth metatarsal.

4:25

If you have a shaft fracture, then of course

4:27

that would be more, uh, more concerning

4:29

and might need to be treated,

4:30

uh, surgically or more aggressively.

4:32

You're gonna see two things

4:34

that are attaching to the base of the fifth.

4:36

Um, so you might be familiar with, um, one of them.

4:39

So this linear structure

4:41

and this hyperintense structure is gonna be the insertion

4:44

for the peroneous brevis.

4:46

Uh, we're used to looking at that more on ankle MRI, um,

4:50

but remember that it does attach to the base of the fifth,

4:53

but it attaches more along the dorsal side.

4:55

So you're seeing that here.

4:56

But when you get to the plantar side, um, you're gonna see

4:59

yet another, uh, linear structure as well,

5:03

a little bit lesser known.

5:04

Um, and this is actually part of the plantar fascia.

5:07

So we just had a case, uh, on the adult side where someone,

5:11

uh, just had what seemed like plantar fascia,

5:13

but it wasn't at the heel.

5:15

And remember that the lateral cord will actually attach

5:18

to the base of the fifth as well.

5:20

So there's, there's a couple of things that attach there.

5:22

And then when we go to the short axis,

5:24

you can sometimes appreciate that.

5:25

So when you're in the short axis,

5:28

you can see coming from dorsal is gonna be

5:30

that peroneous brevis.

5:32

As I scroll down,

5:33

you'll see the peroneous brevis right here attaching

5:36

to the base of the fifth.

5:38

But on the plantar aspect,

5:39

you can see here this little black structure is actually

5:42

attaching to the plantar aspect of the base of the fifth.

5:44

That's your lateral cord of the plantar fascia.

5:48

So base of the fifth, of course,

5:50

is an area that is troublesome.

5:51

You wanna look for bone marrow edema, fractures,

5:53

uls fractures, and things like that.