From the Guidelines
A navicular stress fracture is a high-risk injury that requires immediate treatment and typically 6-8 weeks of non-weight bearing to prevent progression to more serious fractures and complications. The treatment approach should prioritize immobilization, pain management, and gradual return to activity to minimize the risk of delayed union or nonunion, which are common complications associated with navicular stress fractures 1.
Key Considerations
- Navicular stress fractures are considered high-risk due to their tendency for nonunion or delayed union, and therefore, require prompt and aggressive management 1.
- Immobilization using a non-weight bearing cast or boot for 6-8 weeks is essential to allow for proper healing and to prevent further stress on the affected bone.
- Pain management with acetaminophen or NSAIDs can help alleviate discomfort, and physical therapy is crucial for restoring strength and mobility during the recovery phase.
- Early diagnosis through MRI or bone scan is vital, as these fractures can be difficult to detect on regular X-rays, and delayed diagnosis can lead to more severe complications 1.
Prevention and Recovery
- Proper footwear with good arch support and shock absorption is essential for prevention and during recovery to reduce the risk of repetitive stress on the foot.
- Athletes and individuals engaging in high-impact activities should be aware of the risks associated with navicular stress fractures and take preventive measures, such as gradual progression of training and regular monitoring of foot health.
- In severe cases or those that do not heal with conservative treatment, surgery may be necessary to ensure proper healing and prevent long-term complications.
From the Research
Navicular Stress Fracture Overview
- Navicular stress fractures are common in athletes, and their management is debated 2.
- The evaluation and management of navicular stress fractures involve various operative and non-operative adjunctive treatment modalities, including the relevance of vitamin D levels, use of shock wave therapy and bone marrow aspirate concentrate (BMAC), and administration of teriparatide 2.
Treatment Options
- Surgical treatment may be associated with earlier return to sports 2.
- Non-weightbearing cast immobilisation and surgical fixation are two treatment options for navicular stress fractures, with no significant differences found between them for current pain, current function, or abnormality on CT 3.
- However, surgically treated patients more often remained tender over the "N spot" even after returning to competition for two years or more 3.
Risk Factors
- Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with increased stress fracture risk, including navicular stress fractures 4, 5.
- The use of ibuprofen, naproxen, or celecoxib is correlated with an increased incidence of stress fractures, and patients at high risk of stress fracture should avoid regular use of these medications 4.
- Prior receipt of NSAIDs is associated with an increased incidence of stress fractures and delayed healing in active duty service members 5.