Fractures and dislocations at the mid-tarsal (Chopart) and tarso-metatarsal (Lisfranc) joints have a relatively low incidence but a highly variable clinical presentation. They are still frequently overlooked or misinterpreted at first presentation with potentially deleterious consequences for global foot function.

The majority of these injuries result from high-energy trauma and are accompanied by severe soft tissue damage. Careful clinical examination and standardized radiographic projections lead to the correct diagnosis. CT scanning is employed generously to reveal the true extent of the bony injury and for preoperative planning. Urgent reduction of gross dislocations is mandatory to alleviate the strain on the soft tissues. The presence or development of a compartment syndrome has to be ruled out with repeat examinations and treated accordingly with dermatofasciotomy.

The type of internal fixation depends on the individual fracture pattern including K-wires, resorbable pins, screws, and plates. A wide array of anatomically-shaped, interlocking plates is available for stabilization of the talus, navicular, cuboid and calcaneus around the Chopart joint. At the Lisfranc joint, screws are used mainly for stabilization of the 1st–3rd tarsometatarsal joints, while K-wires are preferred for the 4th and 5th tarsometatarsal joints. In cases of severe soft tissue trauma, internal fixation is supplemented by tibiometatarsal external fixation until soft tissue consolidation. With gross instability at the Chopart joint, temporary joint transfixation with K-wires or bridging plates are employed to ensure proper ligamentous healing. There is no general consensus in how long to maintain joint transfixation at the Lisfranc joint.

The best predictor for acceptable results after mid-tarsal and tarsometatarsal fracturedislocations is primary anatomical reduction and adequate internal fixation whereas inadequate joint reduction and/or stabilization almost invariably leads to painful mal-unions or non-unions, residual instability and deformity. Corrective fusion with axial realignment results in a significant reduction of pain and functional rehabilitation.