Understanding the Navicular Stress Fracture.

The Navicular ‘boat shaped’ bone of the mid-foot helps form the medial longitudinal arch of the foot. It forms joints with other foot bones, which allows the foot to move.

Symptoms of navicular stress fracure often come on slowly, and are felt on the top (dorsum) of the foot, and along the inner (medial) arch. There is often a vague and aching pain, aggravated with running and jumping.

If left undiagnosed / not managed properly, pain may come on sooner during activity and persist for longer once the activity has ceased.

Stress fractures occur when bones cannot remodel quickly enough to keep up with the demands placed upon them. This is typically an overuse injury seen in runners or athletes in Pre-Season, as their training ramps up quickly.

Once confirmed on imaging, management may include rest from running, medications, a CAM boot, strapping, surgery, progressive lower limb and ‘core’ strengthening, foot orthoses and progressive re-exposure to training.

Re-imaging is often used to assess the healing of this fracture. Is it extremely important to wean use of the CAM boot slowly, once the bone has reached sufficient healing, so as to let the bone and soft tissues of the foot re-condition. Progressive and gradual exercise is then paramount, to prevent a relapse in pain due to weakened structures.

Prevention includes the appropriate use of training principles in the training / sports program, such as specificity and progressive overload. Biomechanical improvements, strength impairment corrrections and adequate sports nutrition may reduce the risk of such overuse injuries.

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