Tarsal Bone Fractures

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 <a class="external" href="http://www.uth.tmc.edu/radiology/presentations/2008/nutcracker_beckman_2008.pdf" rel="nofollow" target="_blank">Nuts and Bolts of the Nutcracker</a> is recommended for further reading.

Anatomy

The Columns of the Foot

	Medial Column of the foot •1st metatarsal •Medial cunieform •Navicular •Talus
	Lateral Column of the foot •2nd & 3rd metatarsals •Middle & lateral cunieforms •Navicular •Talus
	Lateral 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 <a class="external" href="http://www.uth.tmc.edu/radiology/presentations/2008/nutcracker_beckman_2008.pdf" rel="nofollow" target="_blank">Nuts and Bolts of the Nutcracker</a> . http://www.uth.tmc.edu/radiology/presentations/2008/nutcracker_beckman_2008.pdf

Midfoot Articlations

Midfoot 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.

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).
	The 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.
	Further obliquity from the lateral position has possibly demonstrated the donor site from the cuboid of the arrowed fragment.