Tarsal navicular stress fractures

Area of Science:

• Orthopedics
• Sports Medicine
• Radiology

Background:

• Stress fractures of the tarsal navicular bone are increasingly recognized in active individuals.
• Delayed diagnosis is common due to physician unfamiliarity, negatively impacting patient outcomes.
• These fractures often present as gradually increasing dorsal mid-foot pain in runners.

Purpose of the Study:

• To highlight the diagnostic challenges and treatment strategies for navicular stress fractures.
• To emphasize the importance of early and accurate diagnosis in physically active persons.
• To guide clinicians in managing this specific type of bone injury.

Main Methods:

• Review of clinical presentation, diagnostic imaging, and treatment outcomes for navicular stress fractures.
• Initial diagnosis often involves ruling out other causes of mid-foot pain.
• Advanced imaging, including triple-phase bone scan and computed tomography (CT), is crucial for definitive diagnosis and surgical planning.

Main Results:

• Initial plain radiographs are frequently normal, necessitating further investigation.
• Triple-phase bone scans offer early detection and lesion localization.
• CT scans provide essential anatomic detail for guiding therapeutic decisions.

Conclusions:

• Nondisplaced, noncomminuted navicular stress fractures typically heal with six weeks of non-weight-bearing cast immobilization.
• Displaced, comminuted, or delayed/nonunion fractures warrant surgical intervention with open reduction and internal fixation.
• Increased physician awareness and timely diagnostic imaging are key to successful management.