Citation, DOI, disclosures and article data
Citation:
Feger J, Knipe H, Bell D, First to second metatarsal distance. Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://doi.org/10.53347/rID-96362
The first to second metatarsal distance or M1-M2 distance is the length between the bases of the first and second metatarsal bone and a measurement for the evaluation of midfoot instability.
The first to second metatarsal distance is used for the evaluation and classification of midfoot sprains and Lisfranc injuries 1-4.
The first to second metatarsal distance is measured on the dorsoplantar view of the foot as the shortest horizontal distance between the bases of the first and second metatarsal bones 1,7. Weight-bearing dorsoplantar radiographs of the foot can improve the detection of Lisfranc injuries 3,4.
Adapted from the Nunley-Vertullo classification system 2:
- first to second metatarsal distance <1-2 mm is considered normal
- diastasis of 2-5 mm indicates subtle injury 5,6
- a gap of ≥5 mm is usually associated with a decline in medial arch height and indicates a more severe injury 1-3
History and etymology
The first to second metatarsal distance as a method to evaluate Lisfranc injury was described by the American orthopedic surgeon Tom Faciszewski in 1990 4,5.
A classification system based on the first to second metatarsal distance was introduced by the American orthopedic surgeons James A Nunley and Christopher J Vertullo in 2002 2.
-
1. Lau B, Allahabadi S, Palanca A, Oji D. Understanding Radiographic Measurements Used in Foot and Ankle Surgery. J Am Acad Orthop Surg. 2022;30(2):e139-54. doi:10.5435/JAAOS-D-20-00189 - Pubmed
-
2. Nunley J & Vertullo C. Classification, Investigation, and Management of Midfoot Sprains: Lisfranc Injuries in the Athlete. Am J Sports Med. 2002;30(6):871-8. doi:10.1177/03635465020300061901 - Pubmed
-
3. Grewal U, Onubogu K, Southgate C, Dhinsa B. Lisfranc Injury: A Review and Simplified Treatment Algorithm. Foot (Edinb). 2020;45:101719. doi:10.1016/j.foot.2020.101719 - Pubmed
-
4. Sripanich Y, Weinberg M, Krähenbühl N et al. Imaging in Lisfranc Injury: A Systematic Literature Review. Skeletal Radiol. 2020;49(1):31-53. doi:10.1007/s00256-019-03282-1 - Pubmed
-
5. Faciszewski T, Burks R, Manaster B. Subtle Injuries of the Lisfranc Joint. J Bone Joint Surg Am. 1990;72(10):1519-22. - Pubmed
-
6. Sugino Y, Yoshimura I, Hagio T, Ishimatsu T, Nagatomo M, Yamamoto T. Reliability of Various Diastasis Measurement Methods on Weightbearing Radiographs in Patients with Subtle Lisfranc Injuries. Skeletal Radiol. 2021. doi:10.1007/s00256-021-03892-8 - Pubmed
-
7. Yu-Kai Y & Shiu-Bii L. Anatomic Parameters of the Lisfranc Joint Complex in a Radiographic and Cadaveric Comparison. J Foot Ankle Surg. 2015;54(5):883-7. doi:10.1053/j.jfas.2015.02.021 - Pubmed
Related articles: Alignment of the foot and ankle
- alignment of the foot and ankle
Promoted articles (advertising)
Unable to process the form. Check for errors and try again.