Displaced fractures of the navicular bone can be painful and should be treated early. Treatment options for displaced navicular foot fractures include immobilization, and possible surgery.
In this article, we’ll discuss the treatment options for displaced navicular fractures as well as how long they take to heal.
What Is a Displaced Navicular Bone?
A “displaced” fracture is when the broken fracture fragments are shifted. The navicular bone is a midfoot bone located between the talus and the cuneiform bones.
Displaced navicular fractures can be diagnosed using a combination of physical exam and imaging modalities.
A foot x-ray can help identify a displaced navicular fracture. However, a CT scan or MRI exam can be beneficial in providing more detail about the fracture.
Details about the level of displacement, the angulation of the fracture, and whether the bone are dislocated is important for surgical planning.
Displaced Navicular Fractures and Surgery
In many cases, displaced navicular fractures will require surgery. If the fracture fragments are displaced more than 2mm or there is dislocation of the navicular at the joint level, surgery is often required to realign the fracture fragments so that they can heal.
Surgery for displaced navicular fractures can be done in the outpatient setting under general anesthesia.
Your doctor will clean the fracture site and fix the fracture. Plates and screws will be used to hold the fracture fragments in place.
In general, surgical hardware does not need to be removed unless it becomes painful later on.
The surgery will take 1 to 2 hours. You can go home the same day after surgery.
Healing Time for Displaced Navicular Fractures
After surgery, your doctor will apply a cast on your leg. You will need to stay off of your foot for 6 to 8 weeks total. This is because the bone needs to be able to heal. You can use a knee scooter or crutches to help you stay off of your foot.
Your doctor will get x-rays in their office every 3 to 4 weeks to see if the bone is healing.
If the bone is healing appropriately, your doctor will allow you to bear weight in a cast boot for an additional 4 weeks before transitioning into athletic shoes.
Your doctor will recommend that you complete physical therapy 3 to 4 times a week for 1 month to help improve strength, range of motion, and balance. Being off of your foot for several weeks can cause you to feel weak. That is why physical therapy is essential to full recovery.
Full healing of displaced tarsal navicular bone fractures can take 3 months or more.
Navicular Stress Fractures
Navicular stress fractures typically occur due to repetitive stress being placed on the navicular bone over time. This can be due to activities such as marching, jumping, and dancing.
Certain sporting activities can also cause excessive stress to be placed on the navicular bone.
In many cases, tarsal stress fractures initially start out as non-displaced navicular fractures. However, repetitive activities can cause nondisplaced stress fractures to turn into displaced stress fractures that require surgery.
If you suspect that you have a tarsal navicular stress fracture, it’s important to notify your doctor as soon as possible.
Complications of Displaced Navicular Stress Fractures
A non-union is a complication that can occur after surgery. A non-union is when the navicular fracture fails to heal after 3 months. This can occur due to poor blood supply in the bone, walking on the foot too soon after surgery, or positive smoking history.
Non-unions can be treated using an external bone stimulator machine. External bone stimulators can help heal the bone.
Occasionally, surgery may be needed to repair a non-union. Your doctor will insert a bone graft into the fracture site at the time of surgery to help stimulate healing.
Arthritis can occur after sustaining a navicular fracture. If the fracture extends into the joint, arthritis symptoms can develop. This can cause dull, achy pain in the midfoot.
Arthritis pain can be treated with NSAIDs and steroid injections.
Custom orthotics can help reduce arthritis pain by redistributing pressure away from the midfoot.
Occasionally, nerve damage can occur after surgery. Nerve damage can be temporary or may be permanent. Symptoms of nerve damage include numbness/tingling, burning sensation, and sharp shooting sensations in the feet.
Your doctor can help alleviate pain associated with nerve damage with pain medication and nerve blocks.
When Can You Drive After a Navicular Fracture Is Repaired?
If the fracture was on the right foot, you should wait 6-8 weeks until the fracture is healed to start driving. Driving too soon can reduce the chances that the fracture will heal properly. You should not drive with a cast on your leg.
If your fracture was on the left foot, you can generally start driving 2 weeks after surgery with your doctor’s permission. You should also avoid driving while on narcotics.
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