Navicular Stress Fracture 733.95

synonyms: navicular stress fracture

Navicular Stress Fracture ICD-9

• 733.95 Stress fracture of other bone

Navicular Stress Fracture Etiology / Epidemiology / Natural History

• Secondary to chronic overuse (runing on hard surfaces)
• Generally occurs in sprinters, hurdlers, high jumpers, long distance runners, soccer, basketball players

Navicular Stress Fracture Anatomy

• 20% of people have an accessory navicular

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. Significant edema in the navicular indicates a more acute process. 

Navicular Stress Fracture Classification / Treatment

• Non-weight bearing short leg cast until fx is healed (6-8wks). There is no statistically significant 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.
• Surgery indicated if fracture line extends across two cortices, or across one cortice with displacement or cystic changes.
• High-level athlete: consider ORIF due to high risk of nonunion / prolonged symptoms.
• Consider bone stimulator.

Navicular Stress Fracture Associated Injuries / Differential Diagnosis

• Metatarsal fracture
• Metatarsal stress fracture
• Metatarsalgia
• Jones Fracture
• Navicular fracture

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

1. Boden BP, Osbahr DC. High-risk stress fractures: evaluation and treatment. JAAOS 2000 Nov-Dec;8(6):344-53. 
2. Mann JA, Pedowitz DI. Evaluation and treatment of navicular stress fractures, including nonunions, revision surgery, and persistent pain after treatment. Foot Ankle Clin. 2009 Jun;14(2):187-204.
3. Hunter LY: Stress fracture of the tarsal navicular: More frequent than we realize?  Am J Sports Med 1981;9:217-219.
4. 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.
5. Quirk RM, Foot Ankle Int 1998;19:494
6. Saxena A, J Foot Ankle Surg 2000;39:96