Patients who have endured a navicular body fracture are typically unable to bear any weight on the affected extremity and present with a profound degree of swelling on the dorsal and medial aspects of the foot, all of which is due to the mechanism of the injury and disruption of the medial column of the foot. Patients of avulsion fractures typically present with a significant degree of pain in the midfoot area, particularly during push-off of the fractured segment.

There are several other theories on the forces causing navicular body fractures, though all are due to axial forces on a foot in plantar flexion. A Type-3 injury is a comminuted fracture in the sagittal plane of the bone, with lateral displacement of the forefoot. A Type-2 injury is one that has a dorsolateral to plantar-medial fracture line with medial displacement of the major fragment and forefoot. In this classification, a Type-1 injury is one that occurs in the coronal plane, with no angulation of the forefoot. This system classifies tarsal navicular body fractures according to the direction of the fracture line, degree of disruption of surrounding joints, and the direction of foot displacement. The Sangeorzen classification, devised in 1989, is the leading system for grading tarsal navicular body fractures. Navicular body fractures can be caused either by a direct or an indirect force. Excessive pull from the posterior tibialis tendon can result in medial and tuberosity fractures, and plantar avulsion fractures are secondary to ligamentous injury. In the case of foot dorsal avulsion, fractures result from extreme plantar flexion causing undue stress on the deltoid and dorsal capsules. It is known, however, that stress fractures are a chronic overuse injury associated with microfractures of the bone Traumatic injuries can cause a variety of navicular fracture patterns, including avulsion fractures, tuberosity fractures, and body fractures.Īvulsion fractures of the navicular may occur dorsally, medially, or in a plantar direction, depending on the force applied to the midfoot. While the biomechanics behind stress fractures of the tarsal navicular are somewhat poorly understood, those of traumatic injuries are more comprehensively elucidated. Both of these joints are crucial for inversion and eversion of the foot. The tarsal navicular is an essential component of the Chopart joint, which itself consists of the talonavicular and calcaneocuboid joints. Some literature suggests a zone of avascularity from the central third to the distal cortex of the navicular, which may contribute to the avascular necrosis sometimes associated with these fractures. Supplying the medial plantar aspect of the navicular is a branch of the tibialis posterior artery. The dorsal aspect of the navicular receives vascular supply by the medial tarsal branches of the dorsalis pedis artery, along with branches of the lateral tarsal artery. Considering the large number of articulations found on the various surfaces of the navicular, a large portion of the bone is covered in articular cartilage. The navicular tuberosity, found medially, is the insertion site for the posterior tibial tendon. The largest of these surfaces is found medially with a convex surface, articulating with the medial cuneiform. Anteriorly, the navicular has plantar concavity, with there being three articular surfaces. Posteriorly, the navicular has a biconcave surface which articulates with the head of the talus. The bone’s major oblique axis lies dorsoplantar and lateromedial, with its base situated dorsolaterally, and its apex plantar medial. The navicular is a wedge-shaped bone articulating with the talus, calcaneus, the three cuneiform bones, and the cuboid.

These fractures often require surgical intervention, though they can be treated conservatively in some cases. These fractures are at high risk of nonunion and osteonecrosis owing to the navicular bone’s tenuous blood supply as well as the inherent complexity of the joint. Even though midfoot fractures are relatively uncommon injuries, tarsal navicular stress fractures represent up to one-third of all stress fractures. Fractures of the tarsal navicular bone are most commonly the result of either traumatic injury or undue stress, with the latter having a higher incidence in younger individuals and athletes.

Dorsal navicular