Normal Lisfranc alignment:

• Lines of alignment are represented in red and joint lines are represented in yellow.
• Lines 1 and 2 are assessed on the AP view. Lines 3-6 are assessed on the oblique view.

1. Lateral border of 1st metatarsal is aligned with lateral border of 1st (medial) cuneiform.
2. Medial border of 2nd metatarsal is aligned with medial border of 2nd (intermediate) cuneiform.
3. Medial border of the 3rd (lateral) cuneiform should align with medial border of 3rd metatarsal.
4. Lateral border of the 3rd (lateral) cuneiform should align with lateral border of 3rd metatarsal.
5. Medial border of 4th metatarsal aligned with medial border of cuboid.
6. Lateral margin of the 5th metatarsal can project lateral to cuboid by up to 3 mm on oblique.