Two or three small medial tarsal arteries arise from the dorsalis pedis, curving medially to supply the medial navicular, medial cuneiform, and medial first metatarsal. They contribute to the periosteal blood supply of the medial column.
Medial tarsal artery supply to the navicular is clinically relevant in navicular stress fractures, where watershed central vascularity makes healing unpredictable. Osteonecrosis of the navicular (Kohler disease in children) may relate to disrupted medial tarsal arterial supply. Preservation of these vessels is important during medial column osteotomy.
Repetitive loading fracture through the avascular central third of the navicular, related to its limited medial tarsal arterial supply, producing dorsal midfoot pain in running athletes requiring prolonged non-weight-bearing.
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