What You Should Know About Navicular Stress Fractures

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Author(s): 
John R. Fowler, MD, John P. Gaughan, PhD, Barry P. Boden, MD, and Joseph S. Torg, MD

   The patient wore a short leg cast and was non-weightbearing for six weeks. After cast removal, the patient wore a walking boot for an additional two weeks. He resumed jogging eight weeks after the initiation of his treatment and was able to return to football later in the same season with complete resolution of his symptoms. The patient remained pain free at the most recent follow-up visit.

In Conclusion

The recent literature suggests that patients with navicular stress fractures are undergoing surgery or they are receiving conservative weightbearing management as a first-line treatment option with the expectation that they will return to their activity more quickly.5,26,27 Although surgical treatment seems increasingly common, it remains largely underreported in the literature.

   Patients treated with non-weightbearing cast immobilization for six weeks should expect a successful outcome in over 90 percent of cases and a return to activity in approximately five months.7 First-line surgical treatment resulted in successful outcomes in only 82 percent of cases. Conservative non-weightbearing management is the standard of care for initial treatment of both partial and complete stress fractures of the tarsal navicular.7 Conservative weightbearing treatment is never recommended for navicular fractures and surgical intervention is reserved for failed conservative treatment.

   Dr. Fowler is a fourth-year resident within the Department of Orthopaedic Surgery and Sports Medicine at the Temple University School of Medicine in Philadelphia.

   Dr. Gaughan is an Associate Professor of Physiology and the Director of the Biostatistics and Consulting Center at the Temple University School of Medicine in Philadelphia.

   Dr. Boden is board certified in sports medicine and orthopedic surgery by the American Board of Orthopedic Surgery. He is in private practice in Rockville, Md.

   Dr. Torg is an Adjunct Clinical Professor in the Department of Orthopaedic Surgery and Sports Medicine at the Temple University School of Medicine in Philadelphia. He is in private practice at the Orthopaedic Center in Rockville, Md.

   For further reading, see “Key Insights For Treating Navicular Stress Fractures” in the October 2008 issue of Podiatry Today or “How To Detect And Treat Running Injuries” in the May 2005 issue.




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