Navicular Fracture Clinical Presentation

  • Author: Michael J Ameres, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Jul 28, 2010
 

History

Navicular stress fractures must be considered in any athlete with midfoot pain. Typically, the pain is of insidious onset and may have been present for months. In addition, the pain often worsens with activity and improves with rest. Pain may be present at the dorsum of the foot, or it may radiate along the medial longitudinal arch. Slight swelling may or may not be present.

Historically, persons participating in the following sports and activities have a relatively high risk of navicular fracture:

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Physical

Possible findings from the physical examination in an individual who has a navicular fracture include the following:

  • Tenderness at the "N spot," which is defined as the proximal dorsal portion of the navicular (see the image below). This is the most important physical finding. Palpation of the N spot. Palpation of the N spot.
  • Tenderness at the midmedial arch over the navicular
  • Pain with passive eversion
  • Pain with active inversion
  • Pain that is often reproduced if the patient hops while in the equinus position
  • Possible mild dorsal midfoot swelling
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Causes

The particular cause of stress fractures in athletes or military recruits is often elusive. Obviously, the repetitive stress of their chosen activity leads to the fracture, but identifying a defect in technique, equipment, or schedule of activity is often difficult.

  • Some factors that have been implicated as causes of stress fractures include the following:
    • Starting athletic activity at a high level without a gradual increase in activity over time
    • Starting a second sport and assuming that the body is conditioned to participate at that sport immediately and at a high level. The navicular is at particular risk when runners participate in sports that require jumping and do not take the time for proper conditioning in their new sport.
    • Ill-fitting and/or old, worn equipment
    • Change in running or field surfaces
    • Relative osteopenia
    • Biomechanical abnormality
  • Some risk factors for stress fracture include the following:
    • Female sex
    • Menstrual irregularities[38]
    • Unequal leg length
    • Any medical condition or behavior that may result in relative osteopenia, including smoking, hypothyroidism, steroid use, and rheumatoid arthritis
    • Sudden, significant weight loss
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Contributor Information and Disclosures
Author

Michael J Ameres, MD  Consulting Staff, Department of Emergency Medicine, Southampton Hospital

Michael J Ameres, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Greg Montalbano, MD  Assistant Clinical Professor, Department of Orthopaedics, New York University Medical School

Greg Montalbano, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Sierra Cascade Trauma Society

Disclosure: Nothing to disclose.

Benson Yeh  MD, Vice President, Designated Institutional Official, Chief Academic Officer, Program Director, Department of Emergency Medicine, The Brooklyn Hospital Center; Clinical Assistant Professor of Emergency Medicine in Medicine, Weill-Cornell Medical School

Benson Yeh is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Emergency Medicine, Council of Emergency Medicine Residency Directors, New York Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew L Sherman, MD, MS  Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, University of Miami, Leonard A Miller School of Medicine

Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Pfizer Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor Rafat Farouqui, MBBS, to the development and writing of this article.

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