Have you just injured your navicular fracture on your foot, are you wondering what treatments options are available or if you can walk on your foot.
As a diagnostic radiographer, I see so many navicular fractures in x-ray and I often have patients ask questions about recovery and treatment.
For this article I will base on my knowledge and medical scientific studies to answer your questions.
Happy reading!😄
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: Dec 2024. Written by Juliet Semakula a diagnostic.
Disclaimer: no affiliate links.
▶️ What are the different names of a navicular fracture of the foot?
The navicular bone is an extra bone on the inside bone in the middle of the arch of the foot and within the posterior tibial tendon that attaches to the navicular bone.
In medical terms this bone is also known as.
♦️Navicular bone fracture
♦️Tarsal scaphoid fracture
♦️Scaphoid fracture of the foot
▶️What are the three types of naviculars
⚫Type I is a small round and exists within the tibialis
⚫Type II is larger and connects to the navicular via a cartilage called a synchondrosis.
⚫Type III is the most prominent and connects to the navicular via a bony bridge.
▶️How can you be sure it’s a navicular fracture and not something else? (signs)
Injury to the navicular is most associated with high energy mechanisms such as axial loading or crushing of the midfoot.
Most common symptoms of a foot injury are more like navicular fracture, symptoms alone will not confirm your injury.
When you have injured your navicular, you will experience the following symptoms
🔴Significant pain will be the main sign especially during weight bearing.
🔴Redness or a bruise around the area.
🔴Localised swelling in the inside arch of the foot
🔴Sometimes the pain may cause a limp or difficult to wear shoes.
▶️How to tell if your navicular bone is broken?
When you go to the doctors, you will be examined and an x-ray of your foot will be done.
Usually if there is a fracture it will be projected on the x-ray image and it will look like this on x-ray and CT
Images of x-ray and CT scan.
CT or MRI scans will only be done if there is a need to provide the best bony detail for visualisation of fracture lines and aid in preoperative planning.
▶️How do you treat navicular fracture
Navicular fractures can be complex and difficult to treat. The goal of treatment is always to restore length and alignment.
Also to avoid chronic deformity, arthritis, and loss of motion to the midfoot.
Treatment is usually.
1️⃣ Nonsurgical management consists of a period of immobilization and non-weight bearing
2️⃣Surgical management typically involves open reduction and internal fixation (this is less frequent).
Nonsurgical management:
Here you will be given a rehabilitation plan to follow to help with your healing.
The foot is usually partially immobilised after a navicular bone fracture for example with a small cast or walking boot.
Stage 1️⃣ From week 0 to 4
♦️You will be given a boot which you will wear when walking and take it off when resting.
♦️You may need to use crutches to take some weight off your foot.
Stage 2️⃣From week 4 to 6 weeks
♦️Here you will be advised to gradually discontinue using the boot and crutches.
♦️You can start walking around the house without crutches first
♦️You can wear the boot when you are moving longer distances.
Stage3️⃣ From 6 to 12 weeks
♦️Here the fracture should have consolidated, with less pain and swelling.
♦️You can resume normal activities as pain allows.
♦️Walking longer distances could still be difficult and cause discomfort.
Stage 4️⃣ From 12 week plus
♦️Your bone should have healed completely but symptoms will continue to improve over the next few months
You will be given a follow-up appointment to assess your healing process after 6 to 8 weeks. An x-ray will be done to show how the bone is consolidating.
▶️Why is there sometimes an operation?
Usually if non-operative management fails and your symptoms persist interfering with your everyday activities your doctor may suggest surgery.
Open reduction and internal fixation of a nail or plate allows anatomic restoration of adjacent joint surfaces and preservation of length and stability along the medial column of the foot
The aim is not to disrupt any blood supply but to stabilise the navicular-cuneiform joint to allow proper foot function and avoid any fusion and improve fixation.
x-ray image of a navicular fracture post operation with a nail to help stabilise the fracture site.
Postoperative rehabilitation
Early non-weight bearing mobilization is encouraged to enhance movement.
If there is more significant soft-tissue injury, you will not be allowed to weight-bear for 1–2 days after your operation.
Both operative and nonoperative treatments of navicular fractures are appropriate depending on fracture type and patient expectations for return to normal activity.
Rest assured fractures of the navicular bone generally recover well.
▶️Is it OK to walk on a navicular fracture?
This will depend on the type of fracture, treatment and your doctor or surgeon instructions.
In all cases walking is possible without support or with partial support. Sometimes, full support is allowed from the outset.
In the beginning you will be advised not to put as much weight on the foot as you like. I have seen some people walk normally right from the start using crutches to relieve the pressure.
When your injury has been assessed, your doctor will tell you verbally if you need to walk on the fracture or it will be written in your medical report.
▶️What happens if a navicular fracture is left untreated?
You may get complications from a missed navicular fracture or associated injuries that can result in severe, permanent disability.
You will continue having persistent pain and discomfort especially when walking on the injured feet.
It’s better to get your injury checked to avoid any complications.
Remember the goal of any treatment is to improve foot function, gait and mobility through correction of deformity and painful episodes.
▶️Tips to help with your recovery
♦️Applying ice to relieve swelling.
♦️Try to elevate the foot.
♦️You may be given pain relief such as paracetamol.
♦️Doing simple exercises recommended by your doctor.
▶️Do you need physiotherapy?
Yes, you may need physiotherapy after a navicular fracture, physio will help you gradually resume all your previous activities.
To achieve this, it is sometimes necessary to:
🟢Regain some mobility and flexibility in the forefoot.
🟢 Regain muscle strength in the foot and leg muscles.
🟢Relive your pain by trying balancing exercises
▶️How long does it take to heal and consolidate a navicular fracture in the foot?
The consolidation time is fairly standard, it takes between 6 to 8 weeks for the bone to begin to consolidate properly.
Here is some typical recovery data.
| Phase | Usual recovery time frame |
| Pain and swelling | For up to several weeks to 6 months after injury |
| Resume walking with crutches or without | Immediately |
| Resume walking with support | 6 weeks or sometimes immediately |
| Surgery | 4 weeks rest in a walking boot splint or cast. |
| Bone consolidation | 6 weeks to 8 weeks |
| Return to driving | Once your boot has been removed and you feel confident. |
| Back to work | 1-4 months |
| Back to sports | 2-6 months |
| Total functional and muscular recovery | 4 months to 1 year |
Healing times after a navicular fracture both operated and non-operation.
Here are some data from studies that track people’s recovery from navicular bone fractures (Wang et al. 2022)
⚫Follow-up was obtained in all 27 patients after surgery of a navicular fracture, and it was established that patients had fewer complications, a faster recovery after surgery, and more patient satisfaction.
⚫A recent study demonstrated that 57 out of their 62-patient who had navicular bone fracture, had been able to return to activity after recovery, implying an optimal clinical outcome (Saxena et al. 2017)
As with any fracture, complications after treatment are possible, so you may experience stiffness, residual pain and non-union or necrosis of the bone.
We have come to the end of this article, wishing you a quick recovery🙋
Below are the resources I have relied upon for this article.
Sources:📚
Patel KA, Christopher ZK, Drakos MC, O’Malley MJ. Navicular Stress Fractures. J Am Acad Orthop Surg. 2021 Feb 15;29(4):148-157. doi: 10.5435/JAAOS-D-20-00869. PMID: 33512847.
Fowler JR, Gaughan JP, Boden BP, Pavlov H, Torg JS. The non-surgical and surgical treatment of tarsal navicular stress fractures. Sports Med. 2011 Aug 1;41(8):613-9. doi: 10.2165/11590670-000000000-00000. PMID: 21780848.
Murray J. Penner,Late Reconstruction After Navicular Fracture,Foot and Ankle Clinics,Volume 11, Issue 1,2006,Pages 105-119,ISSN 1083-7515,ISBN 9781416035046.
Marshall D, MacFarlane RJ, Molloy A, Mason L. A review of the management and outcomes of tarsal navicular fracture. Foot Ankle Surg. 2020 Jul;26(5):480-486. doi: 10.1016/j.fas.2019.05.020. Epub 2019 Jun 12. PMID: 31229349.
DiGiovanni CW. Fractures of the navicularhh. Foot Ankle Clin. 2004 Mar;9(1):25-63. doi: 10.1016/S1083-7515(03)00173-6. PMID: 15062213.
Penner MJ. Late reconstruction after navicular fracture. Foot Ankle Clin. 2006 Mar;11(1):105-19, ix. doi: 10.1016/j.fcl.2005.11.003. PMID: 16564456.
Wang C, Fu S, Li X, Wang J, Wu C, Zhang J, Song G, Gu W, Shi Z. Robot-assisted percutaneous screw fixation in the treatment of navicular fracture. Front Surg. 2023 Jan 5;9:1049455. doi: 10.3389/fsurg.2022.1049455. PMID: 36684335; PMCID: PMC9849596.
Saxena A, Behan SA, Valerio DL, Frosch DL. Navicular Stress Fracture Outcomes in Athletes: Analysis of 62 Injuries. J Foot Ankle Surg. 2017 Sep-Oct;56(5):943-948. doi: 10.1053/j.jfas.2017.06.009. PMID: 28842101.