Continued pain with activity after cast removal is a sign that the bone did not heal. The most common complication after treatment of a navicular fracture is a nonunion, or failure of the bone to heal. Recovery after surgical treatment usually requires at least 6-8 weeks of limited weightbearing and foot immobilization in a cast or boot with a gradual return to activities. Surgical treatment involves placement of an internal screw or screws across the fracture. Research shows wearing a cast has an 80-100% success rate.Ĭertain patients, including professional athletes, may choose surgical treatment to allow them to return to activity more quickly and reduce the risk of developing another stress injury. Non-surgical treatment includes wearing a cast or boot without weightbearing for 6-8 weeks. First, you must stop the activity that results in the pain of the stress fracture. Your foot and ankle orthopedic surgeon may recommend surgical or non-surgical options to treat navicular stress fractures. Imaging beyond X-rays such as CT, MRI, and bone scans can be helpful in showing a stress fracture at the navicular if X-rays can’t do this. However, X-rays may appear normal in the early stages of the stress fracture. Standing X-rays may reveal a fracture line. Physical examination will show tenderness across the top of the foot. DiagnosisĪ history and physical exam are important ways for diagnosing a navicular stress fracture. Incorporate stretching, particularly of the calf muscles and Achilles tendon, prior to exercise. Do not increase your walking or running distance increments by more than 10 percent per week. Start your new training routine slowly, especially after a period of relative inactivity. Supportive shoes typically have a stiff sole with lots of cushioning in the shoe, especially at the arch. Select supportive footwear before you start an exercise or training routine and replace your shoes after 300 to 500 miles of use. There are steps you can take to help prevent navicular stress fractures: Repetitive forces that could result in a navicular stress fracture include running/jumping sports (such as basketball) and similar activities, increased exercise, or even walking after a period of inactivity. The bone may break down because of excess force, underlying bone weakness, or a combination of these two factors. This makes it more susceptible to repetitive forces that can cause damage. The navicular is covered by cartilage and lacks a rich blood supply, especially at its center. The navicular bone helps transfer force from the ankle to the forefoot (the ball of the foot). Pain usually improves with rest and support but then returns when activity resumes. Patients with navicular stress fractures usually have gradual onset of aching pain across the top and/or middle of the foot. These fractures often are due to overuse, ongoing forces, and/or stress on the bone rather than a sudden injury. A navicular stress fracture is a crack or break in the navicular bone, which is a boat-shaped bone in the middle of the foot.
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