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What is a Navicular Stress Fracture?

A navicular stress fracture is described as a small crack in the navicular bone (a boat-shaped bone located at the top of the middle part of the foot), which occurs from too much stress being placed on the bone from repetitive activities.

Picture of Navicular Stress Fractures

What are the Causes of a Navicular Stress Fracture?

Some of the factors that might contribute to the development of a navicular stress fracture include:

  • Increased sports training amount, frequency, or intensity
  • Modification of the apparatus, such as new footwear or a new training surface
  • Poor nutrition (vitamin D deficiency and low-calorie intake)
  • Low bone density
  • Atypical foot structure, such as high arches
  • Excessive pronation (inward tipping of the foot)
  • Restricted ankle dorsiflexion (the ability to raise your foot toward your knee).

What are the Symptoms of Navicular Stress Fracture?

Signs and symptoms of a navicular stress fracture include:

  • Swelling or bruising over the middle part of the foot
  • Intense pain
  • Discomfort in the arch and center or top of the foot
  • Tenderness when pushing on the navicular bone
  • Discomfort when moving, running, or leaping. Patients frequently only experience discomfort initially after performing vigorous activities like jogging or leaping. However, it can turn into a steady pain even when at rest and escalate to pain with low-intensity activities like walking.

Diagnosis of Navicular Stress Fracture

Your doctor will review your symptoms, and medical history and perform a thorough physical examination to check for swelling or bruising restricted range of motion, or tenderness. Diagnostic tests that may be ordered include:

  • X-rays: During this study, high electromagnetic energy beams are used to produce images of broken bones. However, stress fractures may be difficult to visualize on X-rays.
  • CT scan: This study creates detailed images of the foot using X-rays from different angles.
  • Bone scan: This is a nuclear imaging study that helps your doctor identify hard-to-detect stress fractures or any bone disorders.
  • MRI Scan: This is an imaging study that uses a large magnetic field and radio waves to produce detailed images of the foot.

What are the Treatments for a Navicular Stress Fracture?

Treatments for a navicular stress fracture include:

  • Rest: Your doctor will advise you to avoid high-impact exercises and activities. Weight-bearing on the affected leg is limited until the area is healed which can take 4 to 8 weeks.
  • Ice: Apply ice for 10 minutes at a time to relieve pain and inflammation.
  • Compression: Pressure should be applied to the affected site to reduce pain.
  • Elevation: You need to elevate your leg when possible, to relieve swelling.
  • Medications: Your doctor will recommend over-the-counter anti-inflammatory medications to reduce inflammation and pain.
  • Physical therapy: After the initial rest period, your doctor will recommend special non-weight-bearing exercises and other techniques to strengthen the bones and improve your range of motion.

If these methods are found to be ineffective, your doctor will recommend using

  • Splints: These are made of plastic and fiberglass and are used to immobilize the joint.
  • Casting: This acts as a protective shell made of fiber or plaster molded in a way to protect the broken bones.
  • Bracing: Braces are made of plaster or fiber and act as a protective shield to align the damaged bone.

Surgery for Navicular Stress Fractures

Surgery is usually not needed to treat navicular stress fractures. However, if non-invasive treatments fail to repair your fracture, surgery may be considered. The fracture is often fixed during surgery using one or more screws, and occasionally a bone graft.

Prevention

These steps you can take to help prevent navicular stress fractures are:

  • Before beginning an exercise or training regimen, choose supportive shoes and replace them when they begin to wear out. Typically, supportive footwear has a rigid sole and is well-cushioned throughout, especially at the arch.
  • Particularly following a period of comparatively little exercise, ease into your new training regimen.
  • Stretching should be done before exercise, with the calf muscles and Achilles tendon receiving special attention.

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