Acute Fracture of the Tarsal Navicular - Presentation of a Case and Review

Author - Aubrey L Malanowski

Patient Summary

A 34 year old woman presents with pain and swelling in the middle portion of her foot. She had fallen while biking in Holland. After examination and xrays, she is diagnosed with an acute fracture of the tarsal navicular and surgery is recommended. The patient is in overall good health.

Patients and Presentation

An acute fracture of the tarsal navicular occurs as a result of direct trauma to the navicular bone, located on the top of the midfoot area. Dropping a heavy object on the foot, twisting suddenly, or falling forcefully can all result in this injury. Children, the elderly, and athletes involved in high impact sports are at the highest risk.

Common Imaging Work-Up

X-rays (radiographs) are often the first scan used in order to determine the location and severity of a fracture. In some cases more sophisticated imaging tools, such as CT and MRI scans, which produce a cross sectional image of the foot, are needed.

Synopsis of Treatments

Treatment depends on the severity of the fracture. Mild fractures can be treated with a short boot or cast. Moderate fractures may be treated with minimally invasive techniques. Displaced fractures are often treated by internal fixation, which involves the placement of pins. Due to the forces that tend to displace the fractures, some cases require the use of a technique known as external fixation. The most severe fractures are treated with a combination of external fixation and internal fixation.

In this particular patient’s case, her moderately severe fracture required a combination of both internal reduction and external fixation. Being treated as an outpatient, she was able to go home immediately following surgery with the assistance of a boot and crutches. Over the course of the following four months, frequent follow-ups indicated excellent progress. At the four month mark, she is now able to wear normal shoes.

Synopsis of Outcome

Recovery time depends on the severity of the fracture. Patients with mild fractures can expect to heal within three to six weeks. Patients with moderate to severe fractures can expect a recovery time of six to eight weeks.

Minimally invasive procedures are now available for navicular injuries. If you would like more information on how these treatments may help you with your particular health concerns, please contact our office.