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Navicular Stress Fracture
synonyms: navicular stress fracture
Navicular Stress Fracture ICD-9
Navicular Stress Fracture Etiology / Epidemiology / Natural History
- Secondary to chronic overuse (runing on hard surfaces)
- Generally occurs in sprinters, hurdlers, high jumpers, basketball players
Navicular Stress Fracture Anatomy
Navicular Stress Fracture Clinical Evaluation
- Vague midfoot pain, insidious onset, wosening with activities.
- Diffuse tenderness in the midfoot.
Navicular Stress Fracture Xray / Diagnositc Tests
- A/P, Oblique, Lateral foot xrays generally normal
- Best seen on CT or MRI. Also visible on bone scan. Generally oriented in the sagittal plane
Navicular Stress Fracture Classification / Treatment
- Non-weight bearing short leg cast until fx is healed (6-8wks). There is no statistically significnat difference in outcomes between NWB casting for 6 weeks (96% successful with average return to activity of 4.9months) compared to surgery (82% successful with average return to activity of 5.2 months). (Torg S, AAOS Now Jan 2010).
- Continued weight bearing without treatment can lead to fragmentation, dislocation and collapse of the medial column.
- High-level athlete: consider ORIF due to high risk of nonunion / prolonged symptoms.
Navicular Stress Fracture Associated Injuries / Differential Diagnosis
Navicular Stress Fracture Complications
- Stiffness
- Nonuion
- Osteonecrosis
- Deformity
- Postraumatic Arthritis
Navicular Stress Fracture Follow-up Care
- NWB x 6 weeks.
- Gradually return to sports with supervised physical therapy after fracture union is demonstrated on xray.
Navicular Stress Fracture Review References
- Hunter LY: Stress fracture of the tarsal navicular: More frequent than we realize? Am J Sports Med 1981;9:217-219.
- Torg JS, Pavlov H, Cooley LH, et al: Stress fractures of the tarsal navicular: A retrospective review of twenty-one cases. J Bone Joint Surg 1982;64A:700-712.
- Quirk RM, Foot Ankle Int 1998;19:494
- Saxena A, J Foot Ankle Surg 2000;39:96
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