Stress Fractures – Navicular: Causes, Symptoms, and Treatment

What Are Navicular Stress Fractures?

A stress fracture in the navicular bone occurs due to repetitive stress or overloading. Unlike acute fractures, stress fractures develop gradually over time as micro-damage accumulates, overwhelming the bone’s ability to heal.

Navicular stress fractures are frequently seen in sports involving running, jumping, or sudden directional changes, such as basketball, soccer, or track and field.

Causes of Navicular Stress Fractures

Repetitive Stress

• High-impact activities that stress the midfoot.

• Poor biomechanics, such as overpronation or high arches (pes cavus), increasing strain on the navicular bone.

Bone Health

• Osteopenia or Osteoporosis: Reduced bone density can increase fracture risk.

• Nutritional Deficiencies: Low calcium or Vitamin D levels impair bone healing.

External Factors

• Training Errors: Sudden increases in intensity, volume, or frequency of exercise.

• Improper Footwear: Lack of adequate cushioning or support.

Symptoms of Navicular Stress Fractures

• Midfoot Pain: Dull or sharp pain on the top of the foot, worsening with activity.

• Tenderness: Localized pain when pressing over the navicular bone.

• Swelling: Mild swelling around the midfoot.

• Activity-Related Discomfort: Pain initially occurs during exercise and subsides with rest but may progress to constant pain if untreated.

Diagnosis of Navicular Stress Fractures

Clinical Examination

• Evaluation of pain and tenderness localized to the navicular bone.

• Gait analysis to identify biomechanical abnormalities.

Imaging

• X-rays: Often do not detect early stress fractures.

• MRI or CT Scans: Gold standard for identifying and assessing the severity of navicular stress fractures.

Treatment for Navicular Stress Fractures

Non-Surgical Management

1. Activity Modification

   • Cease weight-bearing activities that exacerbate symptoms.

   • Use of crutches or a walking boot to immobilize the foot.

2. Physiotherapy

   • Rehabilitation Exercises: Gradual reintroduction of activity focusing on strengthening and improving biomechanics.

   • Stretching: Targeting tight calf and Achilles tendons to reduce stress on the midfoot.

   • Biomechanical Assessment: Identifying and correcting gait abnormalities.

3. Orthotics

   • Custom insoles to offload pressure from the navicular bone and correct foot mechanics.

4. Pain Management

   • Non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief under medical supervision.

Surgical Management

Surgery may be required if:

• The fracture does not heal with conservative treatment.

• The fracture is severe or displaced.

Common procedures include internal fixation with screws to stabilize the fracture and promote healing.

Recovery Timeline

• Immobilization Phase: 6–8 weeks in a boot or cast.

• Rehabilitation Phase: Gradual return to activity over 3–6 months.

• Full Return to Sport: Often takes 6–12 months, depending on the severity of the fracture and adherence to rehabilitation.

Preventing Navicular Stress Fractures

• Gradually increase exercise intensity and duration.

• Wear appropriate footwear with adequate support.

• Include strength training to improve foot and ankle stability.

• Maintain optimal bone health through diet and supplements as needed.

At Palms Physiotherapy & Allied Health, we understand the challenges of navicular stress fractures and provide tailored treatment to help you recover and get back to doing what you love. Contact us today to begin your journey to healing.