Navicular Stress Fracture

Author: Anne D. Walling
Date: March 15, 2001

(Australia--Australian Family Physician, September 2000, p. 875.) Stress fracture of the navicular is the most likely diagnosis in a patient who presents with severe, increasing midfoot pain following an increase in exercise. To locate the navicular, the ankle should be dorsiflexed so that the insertion of the tibialis anterior into the medial cuneiform bone is apparent. The navicular is immediately proximal and will be tender to palpation if stress fracture is present. Patients with navicular stress fractures report increasing pain and difficulty in walking. Plain radiograph may fail to detect any abnormality or may show a fracture line or sclerosis, depending on the time since injury. Bone scan or computed tomography (CT) may be necessary to make the diagnosis. The management of navicular fractures requires six weeks of nonweightbearing, usually by applying a cast below the knee. A graded mobilization program should follow with the progression guided by CT evidence of healing. Surgical internal fixation and bone grafting may be required for delayed union.

COPYRIGHT 2001 American Academy of Family PhysiciansCOPYRIGHT 2001 Gale Group

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