Tarsal Bone FracturesThis is a featured page

Introduction
Tarsal bone fractures are less commonly seen in Emergency Department and can therefore cause difficulties in diagnosis. This page considers all aspects of the radiography of tarsal bone fractures

Acknowledgement
I have drawn extensively from the work of Nicholas Beckmann, MD and Manickam Kumaravel, MD (The Department of Diagnostic and Interventional Imaging, The University of Texas Medical School). Their presentation Nuts and Bolts of the Nutcracker is recommended for further reading.


Anatomy
Radiographic Anatomy - Foot DPRadiographic Anatomy - Foot Oblique
Radiographic Anatomy - Foot Lateral


The Columns of the Foot
Foot- medial columnMedial Column of the foot
•1st metatarsal
•Medial cunieform
•Navicular
•Talus
Foot- middle columnLateral Column of the foot
•2nd & 3rd metatarsals
•Middle & lateral cunieforms
•Navicular
•Talus
lateral columnLateral Column of the foot
•4th & 5th metatarsals
•Cuboid
•Calcaneus


Lateral column of foot provides majority of mobility and weight bearing in the foot, Significant alterations in foot biomechanics occur with lateral column joint disruption or loss of length.

Note that the cuboid articulates with the bases of the 4th and 5th metatarsals and the calcaneum.

Nicholas Beckmann, MD and Manickam Kumaravel, MD Nuts and Bolts of the Nutcracker . http://www.uth.tmc.edu/radiology/presentations/2008/nutcracker_beckman_2008.pdf


Midfoot Articlations

midfoot articulationsMidfoot articulations with forefoot and hind foot
•Lisfranc joint (forefoot articulation, red line)
•Chopart joint (hind foot articulation, yellow line)



Cuboid Fractures
Case 1
This 50 year old male presented to the Emergency Department following a fall from a ladder. On landing his foot became stuck. He was referred for ankle radiography initially then re-referred for foot radiography.
AP footOblique Foot
There is a fracture of the cuboid (arrowed).The fracture of the cuboid appears to be more extensive on the oblique view of the foot (arrowed).
Lateral footThe cuboid fracture is well demonstrated on the lateral foot image and appears to have a large plantar component. The lateral foot position is not true lateral which has tended to demonstrate the lateral column of the foot to advantage. The fracture appears to be a nutcracker fracture of the cuboid.
oblique footFurther obliquity from the lateral position has possibly demonstrated the donor site from the cuboid of the arrowed fragment.



AndyC
AndyC
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