Sports Medicine
Sports Injury Prevention & Rehabilitation

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Navicular Stress Fracture

(Also known as Stress Fracture of the Navicular)
What is a navicular stress fracture?
A navicular stress fracture is a condition characterized by an incomplete crack in the navicular bone. The navicular is the anatomical name given to one of the bones in the mid-foot. It is located at the top of the arch of the foot.
A muscle (known as the tibialis posterior) attaches to the navicular bone. When this muscle contracts, a pulling force is exerted on the bone. Furthermore, weight bearing activity places compressive force through the navicular. When these forces are excessive or too repetitive and beyond what the bone can withstand, bony damage can gradually occur. This initially results in a bony stress reaction, however, with continued damage may progress to a navicular stress fracture.

Cause of a navicular stress fracture

A stress fracture of the navicular typically occurs over time with excessive weight bearing activity such as running, sprinting, jumping or dancing. They often occur following a recent increase in activity or change in training conditions.

Signs and symptoms of a navicular stress fracture

Patients with this condition typically experience a poorly localized pain in the inner arch of the foot or ankle that increases with impact activity and decreases with rest. Occasionally, pain may radiate to the outer aspect of the foot, the second and third toes or the inner aspect of the heel bone. In severe cases, walking may be enough to aggravate symptoms. Other symptoms may include night ache or pain on firmly touching the navicular bone.

Diagnosis of a navicular stress fracture

A thorough subjective and objective examination from a physician may be sufficient to diagnose a navicular stress fracture. Further investigations such as an X-ray, MRI, CT scan or bone scan are usually required to confirm diagnosis and determine the severity of injury.

Treatment for a navicular stress fracture

Treatment for a stress fracture of the navicular typically involves an initial period of rest from weight bearing activity. This most commonly involves a period of 6 - 8 weeks of non-weight bearing immobilization in a plaster cast. Following this, a gradual increase in weight bearing activity and exercise can usually occur as tolerated, provided symptoms do not increase. This should take place over a period of weeks to months with direction from the treating physiotherapist and will vary depending on the severity of the injury.
Patients should also perform pain-free flexibility and strengthening exercises (following the initial period of immobilization) as part of their rehabilitation to ensure an optimal outcome. Alternative exercises placing minimal weight bearing forces through the affected bone should be performed to maintain fitness such as swimming, cycling and water running. The treating therapist can advise which exercises are most appropriate for the patient and when they should be commenced.

Contributing factors to the development of a navicular stress fracture
There are several factors which may contribute to the development of this condition. These need to be assessed and corrected with direction from the treating therapist. Some of these factors include:
  • poor foot posture (especially flat feet)
  • muscle weakness
  • poor flexibility
  • ankle joint stiffness
  • inappropriate footwear
  • inadequate diet
  • inappropriate or excessive training (particularly on hard or uneven surfaces).

Therapy for a navicular stress fracture

Therapy treatment for patients with this condition is vital in to hasten healing, prevent injury recurrence and ensure an optimal outcome. Treatment may comprise:
  • soft tissue massage
  • joint mobilization
  • electrotherapy (e.g. ultrasound)
  • dry needling
  • the use of crutches
  • activity modification advice
  • taping
  • bracing
  • biomechanical correction
  • exercises to improve strength, balance and flexibility
  • education
  • a gradual return to activity plan

Other intervention for a navicular stress fracture
Despite appropriate physiotherapy management, some patients with this condition do not improve and require other intervention to ensure an optimal outcome. The treating doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan, MRI or bone scan, extended periods of plaster cast immobilization, review with a podiatrist for possible orthotics or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the navicular stress fracture. Occasionally, patients with this condition may require surgery to stabilize the stress fracture and aid healing.