How to deal with a navicular stress fracture in the foot?

A stress fracture of the navicular bone in the foot is not a common stress fracture but can be quite disabling to an athlete when it occurs. A stress fracture is an overuse injury that occurs to bone in response to increased activity levels. The navicular bone in the foot is situated just in front of the ankle joint at the top of the arch of the foot. Due to the position that the bone is in, it gets subjected to a lot of loads and if the bone is not adapted to that load, then a stress fracture might occur. Bone is not a solid rigid structure. Bone is a dynamic living structure and is always replacing itself with new bone cells and adapting to loads that get applied to it. With sports activity more load is place on all bones, but the bones adapt and make new bone tissue within the bone in response to those loads. However, if those loads increase too rapidly and the bone is not given time to adapt to those loads, then a stress fracture can result. Due to the location of the navicular bone, abnormal forces can also be higher due to problems with the biomechanics of the foot.

A navicular stress fracture is considered a higher risk stress fracture as there can be long term problems with the blood supply to the bone over the long term if it is not managed properly. The pain typically comes on slowly and increases with increased activity. The pain is typically at the top of the arch, just in front of the ankle joint. A characteristic symptom is pain over what gets called the ‘N’ spots, which is spot tenderness on palpation right on the navicular bone. Imaging such as x-rays or an MRI can be used to confirm the diagnosis, those it may take a few weeks before it shows up on an x-ray.

Once a navicular stress fracture has been diagnosed, you really should cease all sports activity and if the pain is severe enough get into a moon boot or walking cast for up to 4 weeks. This is considered important due to the risk of complications with a navicular stress fracture. You can use the pain on the ‘N’ spot to monitor progress. Not until that has settled can you start to increase weightbearing. Foot orthotics should probably be used early as they can help reduce any abnormal forces that may be going through the navicular bone and support the arch of the foot. The most important part of the treatment is the progressive increase in activity levels. If that is done too quickly, then there is a very high chance that it is going to happen again, and you will have to go through the whole process again. Activity levels need to be very slowing and gradually increased. As more load is put on the bone, it needs time to adapt to that load before anymore increased load is placed on it.