1. To become familiar with the normal anatomy of the midfoot. 2. To recognise and categorise a variety of midfoot fractures and dislocations. 3. To be familiar with and avoid common pitfalls therefore reducing the risk of reporting errors.

Introduction Failure to recognise and treat fractures and dislocations of the midtarsal and tarsometatarsal (TMT) joints of the foot can result in serious long term complications including compartment syndrome, ischaemia, neurological compromise, Charcot’s neuropathy and osteoarthritis.

Anatomy Figure 1 shows an anatomical image of the foot. The midfoot includes the navicular, cuboid, and three cuneiform bones as well as the midtarsal and TMT joints. The tarsal bones are arranged in a proximal and distal row. The cuboid occupies space in both rows. The proximal row contains the navicular and the cuboid. The distal row contains the medial, intermediate, and lateral cuneiforms and the cuboid. Between the mid and forefoot there are five TMT joints. There are also multiple joints within the...

Take Home Message: Midfoot fractures are uncommonly detected. It is essential to check the alignment of the midfoot tarsal and metatarsal bones in order to avoid missing these injuries as prompt diagnosis and appropriate treatment of these fractures are essential for maintaining normal foot biomechanical function.

Dr Philippa Tyler FRCR, Specialist Registrar, Imperial College NHS trust, St Mary's Hospital, London UK

References: 1. Stoller DW, Tirman PFJ, Bredella MA, Beltran S, Branstetter RM, Blease SCP. Diagnostic Imaging: Orthopaedics, 1st Edition, 2004. Amirsys Inc. 2. Mahadevan V, Williams L, Anderson R, Renwick P, Stoller DW. Primal pictures foot and ankle. Primal Pictures Limited 2000. London. Acknowledgements: Foot model images courtesy of Primal Pictures Limited 2000.