The navicular plays a significant role in maintaining the medial longitudinal arch of the foot. Typically, fractures of the navicular are not evident on plain radiographs.

This often leads to a delay in diagnosis, which may result in prolonged disabling foot pain in individuals, particularly young athletes. The 4 types of navicular fractures are cortical avulsion, tuberosity, body, and stress.

Avulsion fracture, the most common fracture of the navicular, is often associated with ligamentous injuries and results from twisting forces on the mid foot. These fractures are commonly treated conservatively, except for avulsion of the posterior tibial tendon insertion (tuberosity fracture), which may be repaired operatively, especially if a proximal dislocation of 1 centimeter or more is present. An avulsion of the posterior tibial tendon insertion must be differentiated from an accessory navicular.

Fractures of the navicular body

Fractures of the body are commonly associated with other injuries of the midtarsal joint. Sangeorzan et al categorized navicular body fractures into 3 types: coronal fracture with no dislocation, dorsolateral to plantomedial fracture with medial forefoot displacement, and last but not least, is the comminuted fracture with lateral forefoot displacement and carries the worst prognosis.

All navicular body fractures with 1 millimeter or more of displacement require open reduction and internal fixation.