Navicular fractures can occur secondary to direct or indirect injury to the navicular bone of the foot. The navicular bone is one of the midfoot bones on the inside of the foot. Navicular fractures are frequently misdiagnosed. Symptoms of navicular fractures include pain and swelling in the midfoot.
In this article, we’ll discuss the anatomy of the navicular bone, the causes of navicular fractures, and common symptoms you can expect to see with a navicular bone break.
Anatomy of the Navicular Bone
The navicular is a “saddle-shaped” or “wedge-shaped bone” that articulates with the talus bone, the three cuneiform bones, and the calcaneus (heel bone). The navicular bone is present on the inside of the foot. The navicular is an important bone in the midfoot. It helps provide stability to the midfoot and also helps transmit forces across the midfoot when walking.
The posterior tibial tendon (the tendon responsible for holding up the arch of the foot) inserts at the navicular bone. Multiple ligaments connect the navicular bone to the adjacent bones.
The dorsalis pedis artery and the posterior tibial artery provide blood supply to the navicular bone. The central portion of the navicular bone, however, has less blood supply, making it vulnerable when it breaks.
Acute navicular fractures are classified into three types: Avulsion fractures, body fractures, and tuberosity fractures.
They have been further classified on the direction of the fracture line as well as joint involvement by Sangeorzans.
Treatment for navicular fractures will depend on whether the fracture is non-displaced (fracture fragments are aligned) or displaced (fracture fragments are shifted), comminuted (multiple fracture fragments), and if there is joint disruption.
Causes of Acute Navicular Fractures
Acute navicular fractures can happen from direct or indirect injuries to the foot. Direct injuries include direct blows to the navicular bone itself or a fall from a height.
The mechanism of action for navicular avulsion fractures is plantarflexion with extreme inversion of the foot. This can cause a piece of the navicular bone to break off.
Axial loading on a plantarflexed foot can also cause a navicular fracture. Axial loading means putting a lot of pressure on something. In this case, it means putting a lot of pressure on the foot when it is bent down at the ankle. This kind of pressure can cause the navicular bone to break.
Causes of Navicular Stress Fractures
Navicular tarsal stress fractures typically happen from the repetitive force being transmitted through the navicular bone. Activities that cause repetitive stress to be transmitted through the bone include running, jumping, marching, and sporting activities. These activities can fatigue the navicular, and cause the bone to crack.
Certain foot characteristics increase the chance of developing a navicular stress fracture. This includes a very high-arched foot, a foot with a long 2nd metatarsal bone and short first metatarsal bone, and a tight heel cord (equinus). These factors can increase stress on the navicular bone.
Other factors that increase the chance of a stress fracture are starting a new workout regimen, and training too fast or too soon.
Improper foot gear, osteoporosis, and eating disorders can also increase the risk of a navicular stress fracture.
Non-displaced navicular stress fractures can be treated with cast immobilization for several weeks. Displaced tarsal navicular stress fractures, however, may require surgery.
Broken Navicular Bone Symptoms
Signs of a broken navicular bone in the foot include:
- Bruising in the middle of the foot
- Severe pain with swelling in the foot (in the case of an acute fracture)
- Dull, achy pain (in the case of a stress fracture)
- Difficulty bearing weight on the foot
- Deformity of the foot may be visible
- Limited range of motion in the foot
- Loss of feeling in the foot
- Redness in the foot
- Limited range of motion in the foot
Treatment for Navicular Fractures
Treating navicular fractures will depend on whether the bone is non-displaced or displaced. Surgery may be needed when the navicular fracture is displaced. Immobilization in a cast boot for 8 weeks is expected.
When Should You See a Doctor for a Navicular Bone Fracture?
If you have severe pain in the midfoot, or pain in the midfoot that persists for more than 2 weeks, you should contact your local medical foot doctor. Prompt evaluation and diagnosis of a tarsal navicular fracture can help reduce pain and ensure a quicker recovery.
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