Surgical Treatment of Tarsal Navicular Stress Fractures

The tarsal navicular is part of the medial column of the foot. It articulates with the talus as well as the cuneiforms. The navicular can be injured with repetitive loading, such as in an athlete, resulting in a stress fracture. Patients complain of pain over the medial midfoot, especially with axial load. Plain radiographs may be normal, and MRI, CT or bone scan may be necessary to confirm the diagnosis. Nonoperative management can be successful with cast immobilization. For competitive athletes with delayed union or nonunion, surgical repair may be indicated. This is accomplished with interfragmentary screws and autogenous cancellous bone graft. Cast immobilization is important to prevent motion at the fracture site during the postoperative healing period. Nonweightbearing restrictions are used for eight to twelve weeks, or until radiographic bony union is verified. Using a comprehensive rehabilitative program, full motion and strength can be expected with eventual return to full athletic activity.