title: Evaluation and treatment of navicular stress fractures, including nonunions, revision surgery, and persistent pain after treatment.
abstract: 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.
authors.affiliation: Department of Orthopedic Surgery, Summit Medical Center, Oakland, CA 94612, USA. jeffamann@sbcglobal.net
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Mann
authors.forename: David I
authors.initials: DI
authors.lastname: Pedowitz
mesh_terms: D016025:Bone Transplantation; D002370:Casts, Surgical; D003937:Diagnosis, Differential; D005593:Fracture Fixation, Internal; D015775:Fractures, Stress / Q000175:diagnosis* / Q000601:surgery*; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D010808:Physical Examination; D012086:Reoperation; D013314:Stress, Mechanical; D013639:Tarsal Bones / Q000293:injuries* / Q000601:surgery; D014057:Tomography, X-Ray Computed