9/21/2023 0 Comments Walking on a navicular fracture![]() It is common to require three, four, or more months to make a full recovery from an undisplaced navicular stress fracture, and it may be a season-ending injury for an athlete. ![]() Surprisingly, if the patient walks on the cast, the rate of healing may fall as low as 25%. Navicular stress fractures can be difficult to treat due to the poor blood supply to the navicular (a good blood supply is needed for healing of any bone injury), and the fairly extensive force that this bone absorbs in both normal walking and in sporting type activities. Good results have been reported when treating undisplaced navicular stress fractures with treatment involving casting, and a period of non-weight-bearing of 6 weeks. Success rates of 85-90% have been reported with this treatment method. Doctors may also recommend the use of a bone stimulator, which is designed to encourage bone healing. However, there is no clear evidence that the stimulator shortens the time to healing. MRI can also be helpful in determining the presence or absence of blood flow to the bone but costs more. In addition, those studies will allow determination of whether the fracture is complete or incomplete through the bone. An MRI or a CT scan will allow the fracture orientation to be identified. In more advanced cases, or in cases where there is degeneration of the talonavicular joint, x-rays will be abnormal.ĭiagnosis can be made with an MRI, a CT scan, or a bone scan. Sometimes a subtle fracture line can be identified. These two situations may increase the force transmitted into the navicular, particularly in patients doing activities that involve them getting up on their toes such as sprinting and jumping. But most commonly, the person with a Navicular Stress Fracture has a normally-aligned foot. There is some suggestion that patients with slightly higher arch feet, as well as patients with an unusually long second toe (the second toe is usually the longest toe anyway), may have an increased risk of developing navicular stress fractures. An astute physician may be able to localize the tenderness to the top of the navicular bone. Certainly, attempts to hop or rise up on the toes of the affected foot will be painful. Physical examination will demonstrate a generalized tenderness around the top of the mid-foot. Pain may be with athletic activities only however, some patients might even have a limp while walking. The relatively vague location of the symptoms makes NSF difficult to diagnose. The symptoms are often generalized to the mid-foot. Some examples include the lead foot of an active golfer, a middle distance runner, or any college or professional athlete performing dynamic repetitive activities. Patients who develop navicular stress fractures will present with a chronic mid-foot ache. Although anyone can get NSF, the most common presentation is in the athlete. However, unlike a typical stress fracture of the metatarsals (which are much more common), these loading episodes tend to be more dynamic. Treatment involves a period of prolonged non-weight-bearing. Navicular stress fractures that are not healing may require surgery to stabilize the fracture with one or more screws. Navicular stress fractures (NSF) are uncommon but serious injuries, characterized by a chronic midfoot ache at the top of the arch of the foot in front of the ankle. The cause is a repetitive chronic load to the midfoot, often from dynamic sporting-type activities. NSF is difficult to diagnose as it may not be seen on regular x-rays.
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