What is a Navicular Stress Fracture?

Navicular stress fractures have been in the media in recent years due to prominent AFL players suffering from them. James Hird from Essendon FC is the most notable but James Bartell, Jack Trengove and more recently Shaun Higgins have all suffered navicular stress fractures during their careers.The navicular bone is located in the inside of the foot. It is a crescent-shaped bone that lies between the forefoot and the rearfoot forming the apex of the arch. During certain forms of exercise it may be repeatedly compressed between the talus and the cuneiforms. The bone is ‘bent’ by the surrounding bones to compress the bone over the convex talar joint surface.

Reduced dorsiflexion of the ankle, a longer 2nd toe than the 1st toe as well as excessive foot pronation have all been suggested as a possible contributing factors to navicular stress injuries. The bone has a poor blood supply, which contributes to its reduced healing rate and inability to withstand repeated stress.

Navicular stress fractures are seen in athletes using explosive force such as jumping or sprinting, such as track and field athletes, footballers, and dancers. Pain is generally felt in the middle of the arch tends to gradually worsen over time. Navicular stress injuries are very serious and can be career-ending. In some cases, the navicular bone can split and crush, essentially ruining the critical joints in the midfoot.
How is it treated?

Due to the severity of this injury, more drastic treatment methods are implemented earlier. A CT Scan or bone scan is used to determine the severity of the fracture and the patient will likely spend a prolonged period in an non-weight bearing cast. If the fracture is more serious or isn’t healing, surgery may be required to pin the bone to facilitate union of the bone. It is paramount the injury is allowed to heal fully without complication as the repercussions can be disastrous.

Andrew Maitland is a sports podiatrist at the Melbourne Podiatry Clinic. Having worked closely with many elite and amateur runners over the years he has helped many people in the prevention and treatment of running injuries.