(see also: Midfoot/Forefoot Fractures; Navicular Frx; Cuboid Frx; Longitudinal Stress Injuries of Midtarsal Joint)
Medial Stress Injury
- type of sprain of the midtarsal joint;
- caused by inversion of the foot, inaddition, fracture subluxation of joint may be found;
Lateral Stress Injury
- this injury is frequently misdiagnosed as an ankle sprain;
- characteristic feature of these injuries is crushing of cuboid or anterior calcaneus as the forefoot is driven laterally;
- avulsion fractures of navicular tuberosity are seen frequently, & navicular may subluxate laterally on the talar head;
- Cuboid Frx is sometimes found with this injury:
- cuboid is crushed between calcaneus and 4th & 5th metatarsals;
- treatment includes initial non wt bearing cast for 6-8 weeks;
Treatment
- often avulsion of navicular tuberosity is felt to be an isolated injury, and attention is not given to entire mid tarsal joint complex;
- non displaced fractures may be treated by short leg plaster immobilization until healed - usually 6 weeks;
- is satisfactory reduction is not possible, try open reduction & K wire fixation or screw fixation;
- when injury to this articular complex occurs in the diabetic patient w/ peripheral neuropathy, aaggressive treatment is indicated to avoid late collapse and Charcot arthropathy