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Navicular Stress FractureInjuries > Foot > Navicular Stress Fracture(Also known as Stress Fracture of the Navicular)What is a navicular stress fracture?A navicular stress fracture is a condition characterized by an incomplete crack in the navicular bone. The navicular is the anatomical name given to one of the bones in the mid-foot. It is located at the top of the arch of the foot (figures 1 & 2). A muscle (known as the tibialis posterior) attaches to the navicular bone. When this muscle contracts, a pulling force is exerted on the bone. Furthermore, weight bearing activity places compressive force through the navicular. When these forces are excessive or too repetitive and beyond what the bone can withstand, bony damage can gradually occur. This initially results in a bony stress reaction, however, with continued damage may progress to a navicular stress fracture. Cause of a navicular stress fractureA stress fracture of the navicular typically occurs over time with excessive weight bearing activity such as running, sprinting, jumping or dancing. They often occur following a recent increase in activity or change in training conditions. Signs and symptoms of a navicular stress fracturePatients with this condition typically experience a poorly localized pain in the inner arch of the foot or ankle that increases with impact activity and decreases with rest. Occasionally, pain may radiate to the outer aspect of the foot, the second and third toes or the inner aspect of the heel bone. In severe cases, walking may be enough to aggravate symptoms. Other symptoms may include night ache or pain on firmly touching the navicular bone. Diagnosis of a navicular stress fractureA thorough subjective and objective examination from a physiotherapist may be sufficient to diagnose a navicular stress fracture. Further investigations such as an X-ray, MRI, CT scan or bone scan are usually required to confirm diagnosis and determine the severity of injury. Treatment for a navicular stress fractureTreatment for a stress fracture of the navicular typically involves an initial period of rest from weight bearing activity. This most commonly involves a period of 6 - 8 weeks of non-weight bearing immobilization in a plaster cast. Following this, a gradual increase in weight bearing activity and exercise can usually occur as tolerated, provided symptoms do not increase. This should take place over a period of weeks to months with direction from the treating physiotherapist and will vary depending on the severity of the injury. Patients should also perform pain-free flexibility and strengthening exercises (following the initial period of immobilization) as part of their rehabilitation to ensure an optimal outcome. Alternative exercises placing minimal weight bearing forces through the affected bone should be performed to maintain fitness such as swimming, cycling and water running. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they should be commenced. Contributing factors to the development of a navicular stress fractureThere are several factors which may contribute to the development of this condition. These need to be assessed and corrected with direction from the treating physiotherapist. Some of these factors include:
Physiotherapy for a navicular stress fracturePhysiotherapy treatment for patients with this condition is vital in to hasten healing, prevent injury recurrence and ensure an optimal outcome. Treatment may comprise:
Other intervention for a navicular stress fractureDespite appropriate physiotherapy management, some patients with this condition do not improve and require other intervention to ensure an optimal outcome. The treating physiotherapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan, MRI or bone scan, extended periods of plaster cast immobilization, review with a podiatrist for possible orthotics or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the navicular stress fracture. Occasionally, patients with this condition may require surgery to stabilize the stress fracture and aid healing. Exercises for a navicular stress fractureThe following exercises are commonly prescribed to patients with a stress fracture of the navicular following removal of their plaster cast and initial immobilisation. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms. Foot and ankle up and downMove your foot and ankle up and down as far as possible and comfortable without pain (figure 2). Repeat 20 times.
Figure 2 – Foot and ankle up and down Foot and ankle in and outMove your foot and ankle in and out as far as possible and comfortable without pain (figure 3). Repeat 20 times.
Figure 3 – Foot and ankle in and out Find a PhysioFind a physiotherapist in your local area who can treat a navicular stress fracture. Physiotherapy products for a navicular stress fractureSome commonly recommended products by physiotherapists for patients with this condition include:
To purchase physiotherapy products for a navicular stress fracture click on one of the above links or visit the PhysioAdvisor Shop. Other Exercises
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Figure 1 - Anatomy of a Navicular Stress Fracture
Figure 2 - Navicular Anatomy (right foot)
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