Navicular Fracture Workup

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

Imaging Studies

See the list below:

  • Radiograph

    • A plain radiograph of the foot rarely demonstrates the presence of a navicular stress fracture. For this reason, negative radiographic findings cannot be used to rule out the presence of a navicular fracture. [39, 40]

    • The tarsal navicular is frequently underpenetrated during routine standing anteroposterior (AP), lateral, and oblique views of foot; however, a coned-down AP radiograph that is centered on the tarsal navicular may help in visualization. The continuity of the cortical bone, especially on an AP radiograph, should be carefully examined because when a fracture is present, the lateral fragment may resemble a separate tarsal bone and can be easily overlooked. However, even with special techniques and a careful examination, a radiograph is not sufficient to rule out a stress fracture of the tarsal navicular.

  • Technetium (99m Tc) bone scanning

    • This study is useful for making the diagnosis of a navicular stress fracture.

    • Increased radionuclide uptake occurs at the navicular.

    • This modality is sensitive to, but not specific for, a fracture; therefore, a computed tomography (CT) scan is necessary for a definitive diagnosis. [40]

  • CT scanning

    • These studies are useful for making and confirming the diagnosis of navicular stress fractures.

    • In addition, a CT scan helps to more precisely define the location and extent of the fracture. Saxena et al proposed a classification system based on CT scan findings as follows [41] :

      • Type 1 involves a dorsal cortical break.

      • Type 2 involves fracture propagation into the navicular body.

      • Type 3 consists of fracture propagation into another cortex.

      • Types 2 and 3 may benefit from early surgical intervention.

  • Magnetic resonance imaging (MRI)

    • MRI is the imaging modality of choice for diagnosing navicular stress fractures.

    • MRI is useful in grading the stress fracture, and thereby, this modality may help the clinician to adjust therapy based on the fracture severity. [42, 43]

    • This study is relatively expensive.

  • Ultrasound [21]

    • Currently, ultrasound is not sensitive enough to be useful in the diagnosis of stress fractures. However, experience with this imaging technique for stress fractures is very limited.

    • The standard caveats for ultrasound apply. The technique is noninvasive but operator dependent. The role of ultrasound in diagnosing navicular stress fractures remains to be determined.

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Laboratory Studies

Vitamin D levels   It is unclear if low vitamin D levels after stress fractures are due to previously undiagnosed deficiency or increased utilization in the setting of an acute fracture.  [44, 45]

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