Navicular Stress Reaction or Fracture

Common Symptoms

Navicular stress reaction or fracture symptoms include vague pain, swelling and bruising at the top inside of the foot which radiates down into the arch.  Pain is associated with a gradual onset and is exacerbated upon weight-bearing resulting in a limp.

 How it occurs

As seen in the image, the navicular is a saddle shaped bone located within the midfoot. This bone is situated on the top/inside of the foot functioning to support the arch and also acting as an insertion point musculature. Navicular stress fractures occurs due to a variety of factors such as:

-          Overuse due to inappropriate and sudden increase of load causing compression of the navicular bone

-          Low or high arched foot types

-          History of midfoot sprains

-          Inappropriate footwear

-          Osteoporosis, poor nutrition, menstrual disorders, low vitamin D levels

What we may assess to obtain a diagnosis

Diagnosis is always subject to symptomatic complaint in conjunction with clinical testing performed by your podiatrist. Test performed may include touching (palpation) of the painful area, joint range of motion and an assessment of your walking or running (gait). 

At The Running Room and Posh Pod, we are equipped with a pressure plate treadmill (Zebris) allowing us to comprehensively assess plantar pressures within the feet. During the acute phase of the injury your podiatrist may send you for an MRI or bone scan with radiographic imaging only appropriate for chronic cases.

Management and how long does it take?

Subject to imaging findings Navicular reaction or stress fracture management modalities and treatment time frames vary on a case-by-case basis. The Navicular bone has scares blood supply and because of this appropriate management is paramount.

In the case of a stress reaction protected weight-bearing and immobilisation for 6-8 weeks is required. Other adjunct therapies may include shock-wave therapy if no contraindications, ankle/calf mobilisation and soft tissue massage. Whereas, for a stress fracture surgical intervention may be considered in collaboration with your general practitioner where an appropriate referral will be made.

Post-operative treatment can be provided by your podiatrist ranging between 6+ weeks. In the latter stages of either a stress reaction or fracture and once bony union has occurred strengthening exercises, footwear advice, orthotic prescription and tapping techniques may also be incorporated into your treatment plan. If there are other factors identified to be causation to the injury collaborative discussions between you, your podiatrist and general practitioner may result in referrals to other health professionals such as, endocrinologist or dietitian. 

Author: Maddie Parker

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