Acute Fractures of the Tarsal Navicular

Tarsal bone injuries are most often incurred during motor-vehicle collisions and other high-energy trauma1. Although uncommon, they are being seen with increasing frequency. This trend is attributed to enhancements in automobile safety that have improved the protection of the abdomen, head, and neck but have left the feet unprotected in the pedal box area2,3. Despite the adverse impact of foot injuries on overall outcome and long-term function in patients with polytrauma, the diagnosis sometimes is not made or is made on a delayed basis as treating physicians focus on more obvious or life-threatening injuries1,4,5. The navicular is the most frequently injured tarsal bone3. In the acute setting, avulsion, tuberosity and body fractures, and comminuted fracture-dislocations can occur. Stress fractures of the navicular represent more chronic, low-energy injuries. They often present with an insidious onset of midfoot pain after an increase in the duration or intensity of exercise or other activity. It is important for orthopaedic surgeons to consider this injury when patients present with vague symptoms in the midfoot …