2 The Mechanism and the Roentgenographic Evaluation of Fracture of the Tarsal Bones

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Abstract
Tarsal fractures are not frequent. In a series of 2,709 consecutive fractures4 only 174 involved the tarsal bones, whereas 1,462 involved the adjacent ankle mortise. The tarsal region is a small area, about half the length of the normal foot, in which are 7 bones, each with several articular facets. These bones and their connecting ligaments and capsules create a complex articular system that allows motion in several directions. These motions are: 1. Dorsiflexion and Plantar Flexion. Upward and downward movements of the foot on a transverse axis through the talus. Most of this motion is in the talocrural joint, but a small amount is in the subtalar joint. 2. Eversion and Inversion. Lateral and medial rotation movements of the heel in the subtalar joint, which take place on an obliquely horizontal axis through the calcaneus. 3. Abduction and Adduction. Lateral and medial deviation of the forepart of the foot on a vertical axis through the midtarsal joint. 4. Pronation and Supination. Complex motions of the foot laterally and medially. In pronation is included eversion of the heel and abduction of the forefoot. In supination is included inversion of the heel and adduction of the forefoot. The ligaments connecting the tarsal bones are short and strong and stabilize the foot and the ankle. These ligaments may be injured, but such injury cannot be seen roentgenographically immediately after the injury unless the ligament is avulsed from its attachment with a large fragment of bone. Some weeks later calcification in the ligament may indicate the site of injury and make it demonstrable in the roentgenogram.

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