From the Research
Medical decision making for a navicular fracture requires prompt diagnosis and appropriate treatment based on fracture type and location, with non-weight bearing cast immobilization being the standard treatment for both partial and complete stress fractures of the tarsal navicular bone, as supported by the most recent and highest quality study 1.
Key Considerations
- For non-displaced navicular fractures, initial management typically involves non-weight bearing with a short leg cast or walking boot for 6-8 weeks, followed by gradual return to activities.
- NSAIDs like ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) can help manage pain.
- For displaced fractures, surgical intervention with open reduction and internal fixation is often necessary to restore proper alignment and prevent complications, as noted in 2.
- Post-surgery, patients should follow a similar non-weight bearing protocol for 6-8 weeks.
Monitoring and Rehabilitation
- Throughout recovery, regular radiographic follow-up at 2,6, and 12 weeks is essential to monitor healing progress.
- Physical therapy should be initiated after immobilization to restore strength and range of motion, typically 2-3 sessions weekly for 4-6 weeks.
- Complications to monitor include avascular necrosis, nonunion, and post-traumatic arthritis, particularly with proximal pole fractures due to tenuous blood supply, as highlighted in 3.
Treatment Approach
- The role of initial surgery is unknown, but surgery provided an earlier return to sport for navicular fractures, as seen in 3.
- For refractory cases, surgical treatment may be required, as noted in 1.
- Minimally invasive fixation and early weight bearing and rehabilitation have been proposed as a reliable and successful treatment regimen, as reported in 4.