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Navicular Stress Fracture

Injuries > 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).

 

                                                 Relevant Anatomy of a Navicular Stress Fracture

Figure 1 - Relevant Anatomy of a Navicular Stress Fracture

 

                                             Navicular Anatomy

Figure 2 - Navicular Anatomy (right foot)

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 fracture

A 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 (such as surface, footwear or technique changes etc).


Signs and symptoms of a navicular stress fracture

Patients with this condition typically experience a poorly localized pain in the inner arch of the foot or ankle that increases with impact activity (such as running, jumping, sprinting and hopping) and decreases with rest. As symptoms worsen, the patient may limp during weight bearing activity and may have to stop activity due to pain.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 or standing 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 fracture

A 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.


Prognosis of a navicular stress fracture

With appropriate physiotherapy management, most patients with a stress fracture of the navicular can make a full recovery (return to sport or full activities) in a period of 3 - 9 months. In more severe cases, recovery may take 1 year, or longer, depending on the intervention required and a range of other factors. In rare cases, some patients may experience ongoing symptoms or complications which may require further management.


Treatment for a navicular stress fracture

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Contributing factors to the development of a navicular stress fracture

There 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:

  • inappropriate or excessive training or activity (particularly on hard or uneven surfaces)
  • inadequate recovery periods from training or activity
  • poor foot posture (especially flat feet or high arches)
  • poor biomechanics
  • muscle weakness (particularly of the gluteals, quadriceps, calf and core stabilisers)
  • muscle fatigue
  • poor balance
  • poor flexibility (particularly of the calf muscles)
  • joint stiffness (particularly of the ankle, heel or foot)
  • inappropriate footwear
  • poor running technique
  • inadequate diet
  • leg length discrepancies
  • being overweight
  • menstrual disturbances


Physiotherapy for a navicular stress fracture

Physiotherapy treatment for patients with this condition is vital in to hasten healing, prevent injury recurrence and ensure an optimal outcome. Treatment may comprise:

  • soft tissue massage
  • joint mobilization
  • joint manipulation
  • electrotherapy
  • dry needling
  • the use of crutches
  • the use of a protective boot or brace
  • activity modification advice
  • arch support taping
  • biomechanical correction (e.g. the use of orthotics)
  • technique correction
  • footwear advice
  • exercises to improve strength, balance, flexibility and core stability
  • education
  • a gradual return to running / activity plan


Other intervention for a navicular stress fracture

Despite 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, the use of crutches or a protective boot, 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 fracture

The following exercises are commonly prescribed to patients with a stress fracture of the navicular following the initial period of immobilisation. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 2 - 3 times daily once the physiotherapist has indicated it is safe to do so and only provided they do not cause or increase symptoms.

Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms


Initial Exercises

Foot & Ankle Up & Down

Move your foot and ankle up and down as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 3). Repeat 10 - 20 times provided there is no increase in symptoms.

Exercises for a Navicular Stress Fracture - Foot & Ankle Up & Down

Figure 3 Foot & Ankle Up & Down (left foot)

Foot & Ankle In & Out

Move your foot and ankle in and out as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 4). Repeat 10 - 20 times provided there is no increase in symptoms.

Exercises for a Navicular Stress Fracture - Foot & Ankle In & Out

Figure 4 Foot & Ankle In & Out (right foot)

Foot and Ankle Circles

Move your foot and ankle in a circle as large as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 5). Repeat 10 - 20 times in both clockwise and anticlockwise directions provided there is no increase in symptoms.

Exercises for a Stress Fracture of the Navicular - Foot & Ankle Circles

Figure 5 - Foot & Ankle Circles


Intermediate Exercises

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Advanced Exercises

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Rehabilitation Protocol for a navicular stress fracture

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Physiotherapy Products for a Navicular Stress Fracture

 

Physiotherapy products for a navicular stress fracture

 

 

Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with a navicular stress fracture include:

  1. Crutches.
  2. Cam Boots
  3. Ice Packs and Heat Packs.
  4. Sports Tape (for foot arch support taping)
  5. Wobbleboards and Duradiscs (for Balance Exercises)
  6. Resistance Band (for Ankle Strengthening Exercises)
  7. Orthotics
  8. Swiss Balls

To purchase physiotherapy products for a navicular stress fracture click on one of the above links, or visit the PhysioAdvisor Shop.


Find a Physio for a Navicular Stress Fracture

 

  Find a Physio

 

 

Find a physiotherapist in your local area who can treat a navicular stress fracture. 


More Exercises

 

  More Exercises

 


More Information

 

  More information

 


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