Navicular Fracture Clinical Presentation

Updated: May 18, 2017
  • Author: Michael J Ameres, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Presentation

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:

  • Track and field [26, 27, 28, 29, 30, 31] – Particularly sports involving jumping and sprinting

  • Ballet and other dancing activities [35]

  • Equestrian sports

  • Basketball

  • Soccer [36]

  • American football

  • Australian-rules football

  • Rugby

  • Gymnastics [37]

  • Military training [28, 32, 33, 34]

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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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