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. doi: 10.1016/j.fcl.2009.01.003.


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.

Publication types

  • Review

MeSH terms

  • Bone Transplantation
  • Casts, Surgical
  • Diagnosis, Differential
  • Fracture Fixation, Internal
  • Fractures, Stress / diagnosis*
  • Fractures, Stress / surgery*
  • Fractures, Ununited / surgery
  • Humans
  • Magnetic Resonance Imaging
  • Physical Examination
  • Reoperation
  • Stress, Mechanical
  • Tarsal Bones / injuries*
  • Tarsal Bones / surgery
  • Tomography, X-Ray Computed