If the patient remains free from pain after 2 weeks after gradually progressing in the jogging regimen, then the athlete may gradually return to full activity over the final 2 weeks of the rehabilitation program (Weeks 5 and 6). Posteriorly, the navicular has a biconcave surface which articulates with the head of the talus 7). Located in the middle of the foot, high compressive forces are focused on this bone, particularly when the foot strikes the ground. McKeon KE, McCormick JJ, Johnson JE, Klein SE. 2013;62:79-91. Richter M, Wippermann B, Krettek C, Schratt HE, Hufner T, Therman H. Fractures and fracture dislocations of the midfoot: occurrence, causes and long-term results. Displaced intra-articular fractures of the tarsal navicular. Risk factors for stress fractures in track and field athletes. Myerson MS, Leonard ME, eds. Other symptoms may include tenderness in the middle of your foot, bruising, or pain that subsides while resting. The navicular tuberosity, found medially, is the insertion site for the posterior tibial tendon. 3 Conservative therapy usually entails variable periods of rest with corrective trimming and shoeing to immobilize the hoof. Navicular bone fractures are usually treated conservatively. Navicular body fractures can be caused either by a direct or an indirect force. The navicular bone helps transfer force from the ankle to the forefoot. Therapy traditionally entails variable periods of rest with corrective trimming and shoeing to immobilize the hoof. Platelet-rich plasma may help bone healing. 2015 Sep;36(9):1117-22. Knapp T, Mandelbaum B, Garrett W Jr. Why are stress injuries so common in the soccer player?. Patients who have suffered a navicular stress fracture typically have a favorable prognosis if treated promptly and appropriately. Curr Rev Musculoskelet Med. Evaluation and treatment of navicular stress fractures, including nonunions, revision surgery, and persistent pain after treatment. These symptoms may worsen when you try to pinch or grasp something. Learn more about these and other causes, and when you should call your doctor. [28, 29, 30, 31] The highest incidence of stress fractures is in jumping and sprinting events. Imaging of stress fractures in runners. Stress fracture injury in young military men and women. Numbness in your wrist can be the symptom of an underlying condition, and the discomfort can extend to your hands and fingers. J Foot Ankle Surg. J Bone Joint Surg Am. People with navicular injury typically have vague pain in the mid portion of the foot – just in front of the ankle. Acute fractures of the tarsal navicular. Several things, from exercise to hot weather, can cause swollen hands. A navicular fracture is a break in the navicular bone on the top of the midfoot. At push-off, the transverse tarsal joint is locked and is helpful in forward propulsion. 19(2):351-68. 1989 Dec;71(10):1504-10. Surgical treatment is generally chosen by athletes wanting to return to normal activity levels at a faster rate. Cohen M, Roman A, Lovins JE. There are several other theories on the forces causing navicular body fractures, though all are due to axial forces on a foot in plantar flexion 32). 2011 May;32(5):S485-92. Towne et al first described stress fracture of the tarsal navicular in 1970 24). Vannini F, Di Matteo B, Filardo G, Kon E, Marcacci M, Giannini S. Platelet-rich plasma for foot and ankle pathologies: a systematic review. 20(1):2-9. Cochrane Database Syst Rev. If the navicular is unstable, then internal fixation is required. They also occur in the wrist, as one of the eight carpal bones at the base of the hand is also known as the scaphoid or navicular bone. Scand J Med Sci Sports. If the postreduction examination findings confirm stability of the navicular, treatment with a non–weight-bearing cast may be sufficient; otherwise, internal fixation is required. Less common but other important causes of Navicular pain include ligament injury, irritation of low back nerves, and Accessory Navicular syndrome. J Bone Joint Surg Am. J Bone Joint Surg Am. Ramadorai MU, Beuchel MW, Sangeorzan BJ. A triple-phase bone scan is highly sensitive and has a high positive predictive value for stress fractures in the navicular, showing uptake on all phases (13). Tarsal navicular fractures can be managed either nonsurgically or surgically, depending on the individual fracture characteristics, such as the size, the degree of displacement, the location, comminution, as well as the condition and integrity of the soft tissues of foot, the presence of additional injuries on the ipsilateral foot, comorbidities and overall functional status 44). Although no trials support the use of bone growth stimulators for navicular stress fractures, they may be a helpful adjunct 55). Navicular fractures often require surgical intervention, though they can be treated conservatively in some cases 4). A stepwise regimen for the course of activity is as follows: Therapeutic Ultrasound may have a role in determining return to play decisions as pain with therapeutic ultrasound has corelated with MRI finding in navicular stress injuries 49). A navicular stress fracture is an injury is often seen in athletes due to overuse or trauma. If physical activity results in pain in the middle of your foot or in your wrist — even if the discomfort fades with rest — consult with your doctor for a full diagnosis and treatment plan that allows the fracture in the bone to heal. Palmar digital neurectomy often is required after the fracture heals to increase soundness. This makes it more susceptible to repetitive forces that can cause damage. Avulsion fractures from the distal border of the navicular bone are relatively common, but normally of little clinical significance. Historically, persons participating in the following sports and activities have a relatively high risk of navicular fracture: Possible findings from the physical examination in an individual who has a navicular fracture include the following: As with most periarticular regions, there are several potential complications and risks associated with fractures of the navicular.
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