Pediatric navicular fractures are a serious injury that can occur in children. It can lead to chronic pain and disability if not diagnosed and treated.
The navicular bone is one of the foot bones located on the inner midfoot. It helps form the arch of the foot and helps with shock absorption.
Children can be susceptible to navicular fractures due to their high activity levels. In many cases, pediatric navicular fractures can be treated conservatively, but there are some cases where surgery may be needed.
Causes of a Tarsal Pediatric Navicular Fracture
The tarsal navicular bone forms in children at ages 2-5 years of age. Acute navicular fractures can occur due to a fall or direct injury to the foot. Tarsal navicular stress fractures may occur in children due to repetitive stress placed on the navicular bone from activities such as jumping, hopping, and running.
Certain foot structures like a high arched foot, or a very low arched foot can cause children to be more prone to developing navicular fractures. Children who are born with weaker bones are also prone to developing navicular fractures.
Symptoms of Pediatric Navicular Fractures
Symptoms can appear vague, especially in the case of a stress fracture. Most children are unable to express their pain and localize their symptoms.
Some of the symptoms of navicular fractures in children include:
- Limping
- Inability to bear weight on the foot
- Swelling with tenderness in the midfoot
- Bruising
- Abnormal foot posture
- Limited range of motion in the midfoot and ankle joint
- Visible deformity of the foot
How Is a Pediatric Navicular Fracture Diagnosed?
If you suspect your child has a pediatric navicular fracture, it’s important to seek medical attention and see your local foot doctor as soon as possible. Your doctor will assess the child’s foot for tenderness, swelling, and deformity.
The doctor will also check for range of motion and any signs of instability in the foot. Imaging tests, such as x-rays, CT scans, and MRI scans, may also be used to help diagnose a navicular fracture.
X-rays can help identify a fracture in the navicular bone. Your doctor will check to see if the navicular fracture is nondisplaced (fracture fragments are aligned) or displaced (fracture fragments are shifted).
X-rays are not always effective in detecting small fractures. CT scans are more sensitive and may be used to evaluate the fracture in greater detail.
An MRI test can be beneficial because it provides detailed images of the fracture and can help identify any soft-tissue damage or ligament injury that may have been caused by the trauma.
How Is a Pediatric Navicular Stress Fracture Diagnosed?
Stress fractures of the navicular bone can be easily missed. This is because unlike acute fractures, stress fractures can take up to 3 weeks to show up on an x-ray.
If your doctor suspects the child has a stress fracture but the x-ray is negative, a bone scan may be ordered.
A bone scan is useful to help diagnose a navicular stress fracture. This test involves injecting a radioactive tracer into the bloodstream, which will bind to areas of increased bone activity. The tracer will emit gamma rays that can be detected by a scanner, helping to identify the fracture.
How Are Pediatric Navicular Fractures Treated?
If the navicular fracture is mild and the fracture is non-displaced, the child can remain non-weight bearing in a cast for 4-6 weeks until the bone heals.
If the fracture is severe and there is significant displacement, your doctor will recommend surgery. Surgery involves placing screws or pins into the bone to hold it in place while it heals.
Children will have to remain off of their foot for 4-6 weeks after surgery in a cast, followed by gradual weight bearing for an additional 2 weeks in a cast boot before transitioning into athletic shoes.
After the fracture has healed, physical therapy will be needed to help the child regain strength and mobility in the affected area. The physical therapist will work with the child to ensure that they are able to move their feet properly, and to help them build strength in the area.
The earlier the navicular fracture is diagnosed and treated, the better the outcome will be.
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