The tarsal navicular is the figurative and literal keystone of the medial longitudinal arch of the foot. Therefore, injuries to the navicular may have a disproportionately profound effect on the overall function of the foot and ankle in comparison with its small size. Even optimally treated injuries can go on to significant posttraumatic sequelae, and leave the midfoot with chronic deformity, arthritis, and loss of motion. This article reviews the posttraumatic sequelae that can be seen after navicular fracture and provides an overview of the treatment principles and alternatives that are available.