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Cortical Avusion & Tuberosity Frx of Navicular

- Discussion:
    - most common type of navicular frx;
    - caused by a twisting force (usually eversion) applied to the foot;
    - acute eversion of foot, resulting in increased tension on posterior tibial tendon or anterior fibers of deltoid ligament, places avulsion pull on navicular tuberosity, producing this fracture;
    - note that this fracture often occurs along w/ compression frx of cuboid; & is part of a larger midtarsal frx;
            - often avulsion of navicular tuberosity are considered to be an isolated injury, & attention is not given to entire mid tarsal joint complex;

- Exam:
    - local tenderness, combined w/ pain on passive eversion or active inversion of the foot;

- Radiographs:
    - frx is best viewed on AP and medial oblique x-rays of foot in equinus;
    - accessory bones of the foot:
            - two accessory osscicles, os supranaviculare & os supraatalare, can occur in this region;

- Treatment:
    - small avulsion fractures are treated w/ short leg cast for 4 to 6 weeks;
    - larger avulsion fractures can be treated w/ internal fixation;
    - in some cases, a painful exostosis will develop, and this can be excised after frx healing