Midtarsal fracture-subluxation. Case report and review of the literature.

Avulsion of the navicular tuberosity in association with fracture at the calcanecuboid joint is a characteristic pattern of injury resulting from an acute valgus and dorsiflexion stress. Only 22 cases of this unusual injury pattern have been reported, and confusion exists regarding treatment. Recommendations for management focus primarily on the calcaneocuboid disruption. Only two of these reports specifically addressed the posterior tibial tendon avulsion. Each component of this injury pattern should be considered separately. Calcaneocuboid fractures should be treated conservatively or operatively, depending on the extent of articular involvement. Conversely, the navicular tuberosity avulsion should be considered as the acute phase of a syndrome potentially leading to a chronic, posterior tibial tendon-deficient foot. Depending on the degree of displacement of the navicular avulsion fracture, prompt surgical intervention may be justified. A 73-year-old woman illustrates the rationale and treatment of a typical case.