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Tuberosity of navicular bone

The tuberosity of the navicular is a prominent medial projection of the navicular bone in the midfoot. It lies just anterior to the talar head and serves as the primary insertion site for the tibialis posterior tendon, making it essential for maintaining the medial longitudinal arch of the foot. The tuberosity also serves as a palpable landmark on the medial midfoot.

This region is clinically significant because it is prone to avulsion fractures, accessory navicular variants, and posterior tibial tendon dysfunction, which may result in progressive flatfoot deformity.

Joints

  • Part of the talonavicular joint (proximal articulation with the talar head)

  • Contributes to articulation with the cuneiform bones anteriorly

Ligament Attachments

  • Spring ligament (plantar calcaneonavicular): Supports talar head beneath navicular tuberosity

  • Dorsal talonavicular ligament: Stabilizes dorsal aspect

  • Intercuneonavicular ligaments: Connect to cuneiform bones

Tendon and Muscle Attachments

  • Tibialis posterior tendon: Main insertion on navicular tuberosity, with slips to cuneiforms, cuboid, and metatarsals

  • Clinical note: accessory navicular may alter tendon biomechanics

Nerve Supply

  • Medial plantar nerve: Supplies capsule of talonavicular joint

  • Saphenous nerve: Cutaneous supply over medial prominence

  • Tibial nerve branches: Contribute articular fibers

Arterial Supply

  • Dorsalis pedis artery: Provides dorsal branches

  • Medial plantar branch of posterior tibial artery: Supplies tuberosity and tendon insertion

  • Anastomoses: Ensure collateral circulation across midfoot

Venous Drainage

  • Drains into dorsal venous arch, then into great saphenous vein medially

  • Deep drainage into posterior tibial and dorsalis pedis veins

Function

  • Serves as primary anchor for tibialis posterior tendon

  • Helps maintain medial longitudinal arch

  • Provides stability to talonavicular articulation and midfoot mechanics

Clinical Significance

  • Accessory navicular bone: Common anatomical variant; may cause pain and tendon dysfunction

  • Avulsion fractures: From excessive pull of tibialis posterior tendon

  • Posterior tibial tendon dysfunction: Weakness at tuberosity leads to acquired flatfoot

  • Overuse syndromes: Medial midfoot pain in athletes or dancers

  • Imaging role: MRI/CT critical for assessing fractures, accessory bones, and tendon pathology

MRI Appearance

  • T1-weighted images:

    • Normal marrow: intermediate-to-high signal depending on fat content

    • Cortical bone: uniform dark low signal

    • Fracture lines or accessory navicular synchondrosis: low-signal linear gaps

  • T2-weighted images:

    • Normal marrow: intermediate-to-high signal depending on fat content

    • Cortical bone: dark low signal

    • Stress or avulsion fractures: bright hyperintense line with marrow edema

    • Tendinopathy of tibialis posterior: increased signal at insertion

  • STIR:

    • Normal: dark suppressed marrow

    • Pathology: bright hyperintense signal in fractures, edema, or tendon injury

  • Proton Density Fat-Saturated (PD FS):

    • Normal: homogeneous low-dark signal with cortical rim

    • Pathology: bright focal signal at insertion for tendinopathy, tears, or fracture edema

  • T1 Fat-Sat Post-Contrast:

    • Normal: minimal enhancement of marrow

    • Pathology: enhancement in stress reaction, tendon insertional enthesopathy, or inflammatory change

MRI Arthrogram Appearance

  • Contrast outlines talonavicular joint and accessory navicular synchondrosis

  • Accessory navicular: contrast may enter synchondrosis, confirming instability or pseudoarthrosis

  • Helpful for distinguishing symptomatic accessory navicular from asymptomatic variant

CT Appearance

Non-Contrast CT:

  • Provides excellent cortical bone detail

  • Cortical bone: hyperdense rim with sharp definition

  • Detects fractures, sclerosis, accessory navicular morphology

  • Avulsion or stress fractures: seen as cortical break or trabecular irregularity

CT Arthrogram Appearance

  • Contrast fills talonavicular joint and outlines cortical margins

  • Identifies articular extension of fracture lines

  • Highlights synchondrosis of accessory navicular when unstable

  • Useful alternative when MRI contraindicated

CT VRT 3D image

Tuberosity of navicular bone 3d

MRI image

MRI image

Tuberosity of navicular bone MRI sagl cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000

CT image

Tuberosity of navicular bone axial CT cross sectional anatomy radiology image-img-00000-00000

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Tuberosity of navicular bone