Non-displaced Navicular Fractures: Causes, Diagnosis & Treatment

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A non-displaced fracture of the navicular is when the navicular bone is broken, but the fracture fragments remain in proper alignment. Navicular body fractures and navicular avulsion fractures can be non-displaced or displaced. 

Non-displaced navicular fractures should be diagnosed and treated early to ensure the best possible outcomes. Treatment for non-displaced tarsal navicular fractures includes immobilization in a cast, rest, and physical therapy. 

Causes of Non-displaced Navicular Fractures

Acute non-displaced navicular fractures occur from direct impact injuries, twisting injuries of the foot, and falls.

Navicular stress fractures occur from activities that cause repetitive stress on the navicular bone. These activities include jumping, dancing, marching, and running. In some people, these activities can cause a crack in the navicular bone. 

How Are Acute Non-displaced Navicular Fractures Diagnosed?

Tarsal navicular fractures are diagnosed with a combination of a physical exam and imaging.

Foot x-rays, MRI, CT scan, and bone scans are all effective in diagnosing navicular fractures.

X-rays can help identify a navicular fracture, and show whether the fracture is non-displaced or displaced.

In some cases (like in the case of a navicular stress fracture) the fracture line may be difficult to see on an x-ray. In these cases, advanced imaging modalities such as MRI, CT scan, and bone scans can be beneficial. 

How Are Tarsal Navicular Stress Fractures Diagnosed?

Stress fractures typically are missed on initial diagnosis. This is because navicular stress fractures often take 3 weeks to be visible on an x-ray. 

An MRI can be helpful in this case because it can help identify an injury to the bone by the presence of bone marrow edema. Bone marrow edema is fluid in the bone that can occur from repetitive injury. 

Immobilization for a Non-displaced Cuboid Fracture

When you are diagnosed with a navicular fracture, you should remain non-weight-bearing in a cast boot for 6 to 8 weeks minimum. This is because it takes 6 to 8 weeks for a fracture to heal. You can use crutches or a knee scooter to help you stay off of your foot during this time. 

If you have a cast on your foot, make sure to keep your cast clean and dry while in the shower. You can use a cast protector to help with this. 

Your doctor will obtain x-rays every 3 to 4 weeks in their office to assess whether the bone is healing properly. If the bone is healing as expected, you can slowly transition into athletic shoes. You should avoid high-impact activities for 2-3 months after the fracture.

Physical Therapy for the Navicular Bone

Your doctor may suggest you complete physical therapy after sustaining a navicular fracture. When you don’t bear weight on your foot for 6-8 weeks, the leg muscles can become weak. This can make walking difficult and impact balance negatively.

It’s important to undergo physical therapy before resuming regular activities. This is even more important if you play sports. 

Physical therapy can help improve strength, range of motion, balance, and decrease pain. Physical therapy should be completed 3 times a week for 1 month. 

Exercises for Navicular Bone Fractures

Exercises that can help strengthen muscles and ligaments include range of motion exercises, calf muscle exercises, and strengthening exercises. 

Range of motion exercises: Sit on the floor with your feet flat. Move your ankle joint in circles, both clockwise and counterclockwise. Increase the range of motion as your ankle becomes more comfortable. 

Calf muscle exercises: Stand facing a wall and place your hands on the wall for support. Keep your body straight and your feet flat on the ground. Push your heel towards the ground and hold for 30 seconds. Do this several times. 

Strengthening exercises: Lay on your back with your feet flat on the ground. Lift your heel off the ground and hold for a few seconds. Then slowly lower your foot back to the ground. Repeat this exercise 10-15 times.  

Treatment for Navicular Fractures That Are Not Healing

Occasionally, navicular fractures may not heal. This could be due to many factors including premature walking on the fracture, smoking history, and diabetes.

If the navicular fracture hasn’t healed in 3 months, your doctor may suggest using a bone stimulator. 

A bone stimulator releases low-frequency, pulsed electromagnetic fields directly to the site of the fracture and stimulates it to heal. You will need to wear the device for 20 minutes- 1 hour a day depending on the manufacturer.

If this doesn’t work, your doctor may suggest surgery. A bone graft may be needed to be inserted into the fracture site to help it heal.

What Happens if a Navicular Fracture Goes Untreated?

If a navicular fracture goes untreated, it can cause chronic pain and joint deformity. This can also result in the loss of mobility in the midfoot. Non-displaced navicular breaks that are not addressed can turn into displaced fractures that will require surgery. 

If you believe you have a broken foot, you should contact your local foot doctor immediately. 

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