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).
Figure 1 – Relevant Anatomy of a Navicular Stress Fracture
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
Contributing factors to the development of a navicular stress fracture
Physiotherapy for a navicular stress fracture
Other intervention for a navicular stress fracture
Exercises for a navicular stress fracture
The following exercises are commonly prescribed to patients with a navicular stress fracture 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
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.
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.
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.
Figure 5 – Foot & Ankle Circles
Rehabilitation Protocol 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:
- Cam Boots
- Ice Packs and Heat Packs.
- Sports Tape (for foot arch support taping)
- Wobbleboards and Duradiscs (for Balance Exercises)
- Resistance Band (for Ankle Strengthening Exercises)
- 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 physiotherapist in your local area who can treat a navicular stress fracture.
- Read about when to use Ice or Heat
- Read about How to use Crutches correctly.
- View detailed information on initial injury management and the R.I.C.E. Regime
- View detailed information on Correct Footwear for running.
- View detailed information on Do I Need Orthotics?
- View detailed information on a Return to Running Program.
- View detailed information on Returning to Sport.
- View our Foot Diagnosis Guide
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