2. AJM Sheet
• Suspected navicular trauma should be
worked up with a primary and secondary
survey. The following describes unique
subjective findings, objective findings,
diagnostic classifications and treatments.
3. AJM Sheet
Subjective
History of trauma ranges from contusions to
ankle sprains to forced abduction/plantarflexion
of the forefoot.
Objective
• Manual muscle testing (MMT) of the posterior
tibialis tendon is important in these cases.
• Multiple view plain film radiographs are
extremely important because of the possible
obliquity of some fractures. CT scans and MR
images may also be necessary for complete
visualization and analysis of stress fractures.
4. Relevant
Anatomy
The navicular is surrounded by a number of joints of
varying stability. The TNJ proximally is very mobile,
while the distal NCJ and lateral NCJ are very stable.
The navicular is also very stable medially because of
the insertion of the PT tendon.
• Vascular anatomy to the navicular can be
extremely important as described by Sarrafian:
• It has been demonstrated that the central 1/3 of the
navicular is relatively avascular.
• The dorsalis pedis artery adequately supplies the
dorsal and medial aspects.
• The medial plantar artery adequately supplies the
plantar and lateral aspects.
• The central 1/3 has variable, radially-projecting
branches from anastomosis of these arteries.
