II. Mechanism

  1. Concurrent Fracture dislocation (high energy injury)
    1. Talocalcaneonavicular joint
    2. Calcaneocuboid joint
    3. Naviculocuneiform joint
  2. Avulsion Fracture (50% of Navicular Fractures)
    1. Plantar flexion with inversion or eversion
  3. Tuberosity Fracture
    1. Eversion injury
  4. Navicular body Fracture
    1. Direct or axial load
  5. Stress Fracture
    1. Tarsal Navicular Stress Fracture

III. Imaging

  1. Weight-Bearing, Three View Foot XRay (AP, lateral, oblique)
    1. Obtain initial and again every 2 weeks until healed
      1. Monitor for nonunion
    2. Findings
      1. Avulsion Fracture
      2. Tuberosity Fracture
      3. Tarsal Navicular body Fracture
  2. Advanced imaging indications
    1. Tarsal Navicular Stress Fracture
    2. May be indicated per specialist recommendation to define Fracture lines and associated Soft Tissue Injury

IV. Management

  1. See Tarsal Navicular Stress Fracture
  2. Minor avulsion Fracture (low energy injury)
    1. Short Leg Walking Cast or boot for 4 to 6 weeks
    2. May switch to hard soled shoe at 4 weeks if healing on XRay and exam
  3. Navicular body Fracture
    1. Short Leg Walking Cast or boot for 6 to 8 weeks
  4. Significant injury with suspected Ligamentous Injury
    1. Non-weight bearing and splint
    2. Orthopedic or Podiatry referral
  5. Orthopedic or Podiatry Referral Indications
    1. Orthopedic referral in most cases
      1. Surgery often required (outside minor avulsion Fractures)
    2. Dorsal Avulsion Fracture affecting >20% of talonavicular joint
    3. Tuberosity avulsion Fracture with >1 cm displacement
    4. Navicular body Fracture
      1. Displacement >1 mm
      2. Shortening >2 mm
      3. Fracture non-union at 6 to 10 weeks

V. References

  1. Orman and Ramadorai in Herbert (2016) EM:Rap 16(12): 8-9
  2. Silver (2024) Am Fam Physician 109(2): 119-29 [PubMed]

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