Navicular fractures of the foot can occur due to repetitive stress on the navicular bone. This is known as a “stress fracture”. Navicular stress fractures can occur from activities such as marching, jumping, and running.
The navicular bone in the foot is located on the inner midfoot. It is located between the cuneiform bones and the talus bone. The navicular bone helps maintain the arch of the foot and absorbs shock during regular activities. However, too much shock on the bone can fatigue the bone and cause it to crack.
It’s important to diagnose stress fractures as soon as possible. Unfortunately, they are often missed on an initial diagnosis. Without treatment, stress fractures can cause pain and disability.
Causes of a Navicular Stress Fracture
As mentioned previously, navicular stress fractures are caused by repetitive stress placed on the midfoot. These fractures are seen with an increasing frequency in physically active persons.
Track and field athletes who sprint have a higher chance of developing a navicular stress fracture due to excessive stress on the midfoot. The presence of navicular tarsal stress fractures can be seen more often in sports such as soccer and basketball.
The central ⅓ of the navicular bone is avascular. This increases the chance that the bone will fatigue in this area, causing navicular body fractures.
Symptoms of Navicular Stress Fractures
Since stress fractures occur due to repetitive stress of the navicular bone over time, symptoms are not quite as obvious as in the case of acute fractures.
Some of the symptoms of a tarsal navicular bone stress fracture include:
- Dull, achy midfoot pain
- Swelling of the midfoot
- Bruising of the foot
- Inability to bear weight on the foot
- A “crunching” sound in the midfoot
- Pain that is alleviated with rest
- Redness or warmth in the area of pain
How Is a Navicular Bone Fracture Diagnosed?
If you suspect that you may have a fracture of the midfoot, you should contact your local foot doctor immediately.
You should avoid walking or running with a navicular stress fracture. This can cause further damage to the bone and cause the fracture to displace (shift).
Your doctor will perform a physical exam and look for signs of swelling, and tenderness in the foot.
Your doctor will obtain x-rays of the foot to see if there is a navicular fracture. X-rays can usually be done at your doctor’s office. An x-ray will help identify the presence of a fracture and will also show whether the fracture is a nondisplaced navicular stress fracture or a displaced navicular stress fracture.
In many cases, navicular stress fractures may be missed on x-ray. This is because stress fractures can take 3 weeks to show up on an x-ray.
If this is the case, your doctor may recommend advanced imaging such as Magnetic Resonance Imaging (MRI) or Computed Tomography scan (CT).
An MRI is an advanced imaging test that can be used to identify the presence of a stress fracture. An MRI will show the presence of edema (water in the bone from injury) and can identify a fracture line.
An MRI can also identify the presence of soft tissue injury in the foot. The posterior tibial tendon (the tendon that inserts into the navicular bone), can become damaged when the navicular bone fractures. An MRI can show the level of damage present in the tendon. If there is extensive damage to the tendon, your doctor may choose to surgically repair it.
In some cases, a CT scan can confirm the presence of a navicular stress fracture. A CT scan will show detailed images of the fracture including the cortical bone (outer layer of bone).
The fracture line is visible on a CT scan as well as the level of displacement present. It can identify if fracture fragments are shifted, angulated, and rotated. This is important for surgical planning.
A bone scan can be used to diagnose a navicular stress fracture. The scan helps to identify areas of the bone where there are changes in the blood flow or metabolic activity that may indicate a fracture may be present.
Treatment for a Stress Fracture
In many cases, navicular stress fractures can be treated with immobilization in a cast for six weeks. This is because bone healing takes six to eight weeks minimum to heal.
Your doctor will obtain x-rays of the foot every three weeks to assess bone healing.
If the bone has healed after six weeks, you can transition to wearing athletic shoes.
Your doctor will then recommend that you start physical therapy. Physical therapy should be performed three times a week for one month to help improve strength, balance, and range of motion and decrease pain.
If the navicular stress fracture is displaced or doesn’t heal with cast immobilization after six weeks, your doctor will recommend surgery.
Your doctor will repair the stress fracture using plates and screws. After surgery, you will need to remain off of your foot in the cast for six to eight weeks, followed by gradual weight-bearing in a cast boot for an additional four weeks before returning to athletic shoes.
Physical Therapy will be needed for one month after surgery.
Full recovery after surgery can take three months or longer.
What Is a Navicular Stress Fracture Hop Test?
The navicular stress fracture hop test is a test used to assess the risk of a navicular stress fracture. It involves having the person hop on the affected foot while observing for pain or discomfort in the area of the navicular bone. If pain or discomfort is present, it may indicate a navicular stress fracture is present.
Navicular stress fractures of the foot are serious injuries and should be diagnosed and treated promptly. Untreated navicular fractures can cause chronic pain and disability. This can limit a person’s ability to return to regular activities. If you suspect you have broken your midfoot bone, contact your foot doctor immediately.
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