Dorsal Approach to Midfoot

Curved dorsal incision marked between the first and second metatarsals over the tarsometatarsal joints for open treatment of a Lisfranc inju
Curved dorsal incision marked between the first and second metatarsals over the tarsometatarsal joints for open treatment of a Lisfranc injury. Image from Yongfei F, Chaoyu L, Wenqiang X, Xiulin M, Jian X, Wei W. Clinical outcomes of Tightrope system in the treatment of purely ligamentous Lisfranc injuries. BMC Surg. 2021, 21(1), 395. CC BY 4.0.
Dorsal Approach to Midfoot, nerves of the dorsum of the foot, gray’s anatomy plate 836
Nerves of the dorsum of the foot, Gray’s Anatomy plate 836. Image by Henry Vandyke Carter, Wikimedia Commons, Public domain.

Options

  • Dorsomedial incision
    • TN joint
    • Navicular medial cuneiform joint
    • 1st TMT joint
  • Dorsolateral incision
    • CC joint
    • Base of 5th MT

Position

  • supine

Landmarks

  • 1st TMT joint
  • tubercle of navicular
  • base of 5th metatarsal

Incision

  • Longitudinal incision directly over the area to be exposed

Superficial Dissection

  • cut down directly onto bone
  • taking care to avoid any cutaneous nerves that can be identified
  • ensuring the skin flaps are as thick as possible

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.