Midfoot Fracture

The midfoot  is the portion of the foot that sits between the hind foot and forefoot. It is composed of the cuboid, navicular and cuneiform bones .

NAVICULAR FRACTURE

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.

The navicular is a wedge-shaped bone articulating with the talus, calcaneus, the three cuneiform bones, and the cuboid.

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

DIAGNOSIS

X-ray and CT Scan are two basic tools to diagnose navicular fracture.

MANAGEMENT

Tarsal navicular fractures can be managed either nonsurgically or surgically, depending on the individual fracture characteristics, such as the size, the degree of displacement, the location, comminution, as well as the condition and integrity of the soft tissues of foot, the presence of additional injuries on the ipsilateral foot, comorbidities and overall functional status.

Nonoperative treatment includes immobilization, and protected weight bearing for a period of six to eight weeks.

However, patients with high functional demand, such as athletes one should go for surgical intervention. In the event of surgical intervention, these fractures may undergo repair with either screws or plates.

Navicular fracture photos.

CUBOID FRACTURE

The cuboid is a cubical-shaped bone on the outside portion of the midfoot. The cuboid connects to your heel bone, and the outer forefoot and midfoot bones. Although the cuboid bone is not a direct weight-bearing bone, its function is very important when it comes to stability in the foot when standing and walking.   

Cuboid fractures can occur due to direct high-impact crush injuries in the foot, such as car accidents, or falls from heights.

Cuboid fractures can also occur when something heavy falls on your foot. The cuboid bone gets crushed and this is referred to as a “Nutcracker fracture”

What Are the Symptoms of a Cuboid Fracture?

• Pain with pressure on the outside portion of your foot
• Swelling with bruising on the outer midfoot
• Fracture blisters may be present 
• Inability to bear weight on the foot
• Limping when attempting to walk

How Is a Cuboid Fracture Diagnosed?

X-ray and CT Scan are two basic tools to diagnose cuboid fracture.

How Do You Treat a Cuboid Fracture?

If your cuboid bone is non-displaced (broken but in proper alignment), you may be in position of non-weight bearing in a below knee cast or cast boot to the affected foot for 6 weeks minimum.

Displaced Cuboid Fractures

If your cuboid bone is comminuted (multiple fragments)  you will need surgery.