Dorsal avulsion fractures of the tarsal navicular (see figure above) are caused by the pull of the talonavicular ligament and joint capsule during acute foot plantar flexion.
Medial avulsion fractures of the tarsal navicular occur at the navicular tuberosity due to pull from the posterior tibialis tendon during eversion injuries.
Medial avulsion fractures may be associated with anterior calcaneal or cuboid fractures or injury to the calcaneocuboid joint. The last is also known as a nutcracker fracture of the cuboid, which occurs when abduction of the forefoot compresses the cuboid between the bases of the fourth and fifth metatarsals distally and the calcaneus proximally.
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