Presentation
Tripped. Pain located at the level of the ankle.
Patient Data
Because pain was mainly located at the ankle, standard AP and lateral ankle views were performed.
Normal tibiotalar joint and no joint effusion at this level. Slight irregularity on medial side of navicular, but a fracture cannot be substantiated.
Although no fracture was demonstrated, based on clinical suspicion foot and ankle were casted.
Continuing pain. CT was performed to evaluate if any fracture could be visualized.
There appeared to be extensive comminutive fracturing of several structures:
- comminutive fracture of navicular with dislocated fragment medially (visible on X-ray)
- comminutive fracture of cuboid
- fragment on anterolateral side of calcaneus
- involvement of lateral cuneiform
Case Discussion
These fractures involve the cuboideonavicular joint and the mid-tarsal joint, also known as the transverse tarsal joint or Chopart's joint, which consists of two joints:
- articulation between calcaneus and cuboid (calcaneocuboid joint)
- articulation between talus, navicular and calcaneus (talocalcaneonavicular joint), which is a ball (talus) and socket (concavity of posterior surface of navicular and anterior articular surface of calcaneus) joint
This case demonstrates the possible underestimation on conventional X-ray imaging of fracture extent and the importance of clinical findings when considering additional imaging investigations.
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