Fractures and Dislocations of the Tarsal Navicular

Fractures of the tarsal navicular are commonly the result of trauma or chronic overload. Because of its complex anatomy and blood supply, the tarsal navicular is susceptible to osteonecrosis, and injury to this bone can lead to posttraumatic arthrosis of the surrounding joints. Diagnosis of the injury, especially in patients with stress fractures, can require a high index of suspicion and the use of advanced imaging. The treatment of stress fracture is controversial and ranges from immobilization in a non-weight-bearing cast or boot to internal fixation with or without bone grafting. Traumatic fractures are treated with open reduction and internal fixation with or without external fixation for medial and lateral column stabilization. To avoid a poor outcome, concomitant injuries must be recognized and treated. Despite appropriate treatment, patients may ultimately require fusion procedures to address ongoing pain and disability.