Figure 1. Anteroposterior radiograph of left foot.
Figure 2. Oblique radiographic view of left foot.
Figure 3. Lateral image of left foot.
A 50-year-old man presents to the orthopedic office with a left foot injury. He sustained the injury 2 days ago after falling off a ladder. The patient reports that his left foot landed flat on hard ground when he fell from a height of about 6 feet. He has pain and swelling in the foot and is unable to put any weight on it.
On physical examination, there is some swelling around the midfoot and tenderness to palpation over the dorsum of the navicular. Distal neurovascular status is intact. Anteroposterior, oblique, and lateral radiographs are ordered (Figures 1-3, respectively).
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The patient sustained a tarsal navicular body fracture with 4- to 5-mm displacement. The navicular bone is an important supporting structure in the midfoot. During walking, the navicular bone allows the foot to be more flexible during heel strike and more rigid when pushing off from the toes.1
Navicular fractures are described as avulsion fractures, tuberosity fractures, and body fractures. Avulsion fractures account for 50% of acute navicular fractures and represent a disruption of the dorsal talonavicular ligaments.1 Body fractures are further divided into 3 subtypes (Type 1, 2 or 3) based on fracture orientation and comminution.2 Computed tomography scan is routinely ordered for displaced fractures to better characterize the fracture pattern.
Nonoperative treatment is recommended for small avulsion fractures, nondisplaced body fractures, and tuberosity fractures with less than 2-mm of displacement.1 Simple body fractures requiring surgery are usually treated with 2 interfragmentary screws; while more comminuted displaced fractures may require plate and screw constructs.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants.
1. Rosenbaum AJ, DiPreta JA, Tartaglione J, Patel N, Uhl RL. Acute fractures of the tarsal navicular a critical analysis review. JBJS Rev. 2015;3(3):01874474-201503030-00004. doi:10.2106/JBJS.RVW.N.00055
2. Moore DW. Tarsal navicular fractures. OrthoBullets. Updated January 7, 2020. Accessed March 15, 2021. https://www.orthobullets.com/foot-and-ankle/7033/tarsal-navicular-fractures