Navicular fractures in elite athletes-2025 International Foot and Ankle Sports Consensus and systematic review

Navicular injuries are a significant concern in athletics, often leading to prolonged recovery periods and risks of further complications. Navicular stress fractures, in particular, have gained recognition as common injuries among athletes, especially in high-impact sports. The management of navicular injuries remains controversial, lacking standardised treatment protocols. The purpose of the present systematic review and consensus process was to provide up-to-date recommendations on workup and diagnosis, operative and nonoperative treatments, and the return-to-sport (RTS) for elite athletes with navicular fractures.

A consensus process was conducted using a modified Delphi technique with two rounds of questionnaires. 'General consensus' was defined as 75%-85% agreement, 'strong consensus' as 86%-99% agreement, and 'unanimous consensus' as 100% agreement. In addition, a systematic review was conducted evaluating the workup, treatment and postoperative management of Navicular injuries in athletes.

Thirty-four consensus statements were established regarding the diagnosis, management and RTS following navicular fractures in elite athletes; 10 achieved unanimous consensus, 21 reached strong consensus and 2 did not reach consensus. Across 319 athletes identified in the systematic review, those treated surgically returned to sport at a mean of 8.2 weeks postoperatively, with 98.7% resuming competition. The panel reached a strong consensus that athletes should remain nonweightbearing for 4-6 weeks following surgery and may expect to return to full sport within 4-6 months, supported by corresponding timelines in the literature.

Athletes sustaining navicular fractures can typically expect a functional recovery, with most returning to play within 4-6 months after surgery. The consensus recommendations provide the first standardised, evidence-based framework for postoperative progression, including a 4-6 week nonweightbearing phase and structured rehabilitation milestones. These findings guide clinicians in optimising recovery and RTS outcomes in elite athletes.

Level V.