Despite increased awareness of stress fractures of the tarsal navicular and a heightened index of suspicion by those physicians evaluating sports related foot pain, these injuries remain difficult to diagnose. There is often a considerable delay in the diagnosis because of its subtle and often vague clinical presentation. Accompanying a thorough history and physical, the authors recommend plain radiographs of the foot and ankle, followed by a CT scan to fully characterize any fracture of the navicular and to rule out other etiologies of foot pain. If a CT scan is negative, and a high clinical suspicion persists, an MRI scan is then obtained to rule out a stress reaction. While often successful, non-operative treatment of navicular stress fractures is prolonged and often frustrating to the competitive athlete; surgical intervention for appropriately selected patients can result in full symptom resolution and a return to the desired level of athletic participation.