Navicular bone fracture of the foot
The fracture of the navicular bone in the foot is a fracture frequently considered non-surgical, but it can have a considerable impact on the mobility and stability of the ankle and foot with repercussions on the quality of life of affected individuals. Located in the center of the foot, this bone plays a key role in load distribution and the stability of the ankle and foot. It is therefore important to fully understand what this entails, whether you are an athlete or simply active on a daily basis.
Fracture of the navicular bone of the foot
The navicular bone, also known as the tarsal scaphoid, is a fundamental part of the architecture of our foot, located inside the medial arch. It plays an important role in the stability and mobility of our foot. A fracture of this bone, often caused by severe trauma or repeated strain, particularly in the context of stress fractures, can cause intense pain and functional limitations that can really impact your daily and athletic life.
Anatomy and function of the navicular bone
The navicular bone, with its lens shape, has a concave side and a convex side, and it articulates with several other bones of the foot, including:
- The talus: The concave side of the navicular connects to the talus to form the talonavicular joint, which is involved in the movements of the hindfoot and midfoot.
- The medial, intermediate, and lateral cuneiform bones: The convex side of the navicular connects to the cuneiform bones through 3 articular facets forming what is called the inominant joint.
It also helps absorb shocks, and provides mobility and stability to the foot, especially on rough or unstable ground. Other pathologies can also affect this region, such as humpbacked tarsus, a deformity that can impact the biomechanics of the foot.
Causes and mechanisms of a navicular bone fracture
Fractures of the navicular bone of the foot most often occur as a result of direct or indirect high-intensity trauma. They can notably be observed during high-energy falls, such as those caused by road accidents or certain high-energy sports accidents, which generally result in complex injuries and may require specific osteosynthesis techniques.
They are also common in pivot-contact sports such as football or basketball, where sudden and forced movements can provoke a fracture. Finally, they can result from crush injuries, particularly among manual laborers, where foot compression is a typical mechanism of navicular fracture.
Fatigue fractures or insufficiency fractures
Fatigue fractures, also known as stress fractures or insufficiency fractures, are caused by abnormally repeated and significant mechanical stress on the bone. They are generally found in:
- Athletes: Due to intensive training and excessive loads on the foot. It is mainly a sudden increase in training frequency or intensity that is responsible for fatigue fractures.
- Runners: Especially those who rapidly increase their mileage, with unsuitable shoes or insufficient cushioning. The lockdown led to the rise of new runners, and with them, an increase in fatigue fractures, particularly of the navicular bone.
- More sedentary individuals can also experience stress fractures, when suddenly increasing the distances covered, often with unsuitable shoes.
These fractures may go unnoticed at first, presenting as intermittent pain that intensifies over time. It is important to pay attention to the characteristics of the pain, which generally guide the diagnosis of navicular stress fracture.
Symptoms of navicular bone fracture
The fracture of the navicular bone generally presents with characteristic clinical signs. Among them, pain and swelling are particularly prominent.
- Severe pain: The pain is generally significant, preventing weight-bearing on the fractured side. Palpation of the navicular causes intense pain.
- Swelling: A navicular fracture is accompanied by considerable initial swelling, and a hematoma and bruising appear rapidly.
In cases of insufficiency fractures, the pain is persistent with nocturnal exacerbation, but generally allows weight-bearing. Swelling, hematoma, and bruising may be mild.
Functional impairment
The symptoms of this fracture are not limited to pain and swelling. They can also provoke functional limitations that disrupt your daily life. Mobilization of the ankle and foot often becomes painful, which considerably restricts your movements. In addition, there is sometimes a sensation of instability that makes walking uncertain and increases the risk of falling, particularly due to giving way of the lower limb.
Diagnosis of a navicular fracture
A navicular fracture is first suspected during the clinical examination. The doctor takes into account the patient’s profile, identifies visible signs (swelling, bruising, deformity), and checks for painful areas as well as possible vascular or nerve involvement.
The diagnosis is then confirmed by imaging: radiography is the basic examination, MRI is particularly useful for stress fractures and the study of soft tissues, and CT scan provides details on the morphology of the fracture to prepare for possible surgery. To learn more about the different foot examinations available, see our detailed guide.
Treatment of a navicular bone fracture
In some cases, orthopedic treatment can achieve healing of a navicular fracture. This treatment is primarily based on immobilizing the foot and ankle using a splint or a cast. This stabilization limits the risk of secondary displacement of the fracture and also provides the best pain relief. The process of bone healing generally requires several weeks of strict immobilization.
Rest is also essential, as reducing activities that could worsen the fracture promotes bone healing. In addition, applying ice and elevating the foot help to reduce swelling and relieve pain. Finally, after the immobilization period, physical therapy rehabilitation becomes essential to gradually restore joint mobility as well as stability of the ankle and foot.
Surgical treatment
In cases of displaced navicular fracture or associated dislocation, a surgical procedure will be recommended. Surgical options include :
- Open reduction and internal fixation : Stabilizing a navicular fracture is difficult; it requires the use of one or more screw plates to encircle the navicular.
- Percutaneous fixation : This technique is used for stress fractures and in cases of delayed bone healing.
- Fixation with bone grafting : Bone grafts may be necessary in cases of impaired bone healing or pseudarthrosis.
Each method has its advantages and disadvantages. The choice between orthopedic and surgical treatment requires consultation with a specialist in ankle and foot conditions. For complex fractures, expertise in foot fracture surgery is essential.
Rehabilitation and recovery after navicular fracture
Rehabilitation after a navicular bone fracture plays a key role in regaining optimal function of the foot and ankle. It helps to relieve pain and discomfort related to the trauma, to restore a normal gait after prolonged immobilization, to recover mobility and muscle strength (two essential elements for resuming your daily activities), and to limit the risk of long-term complications, such as stiffness. Specific foot rehabilitation exercises are essential in this process.
Recovery outlook
The importance of functional recovery varies depending on several factors, including:
- The severity of the fracture.
- The patient's age and lifestyle.
- The quality of fracture reduction in case of surgical treatment.
- Commitment to the rehabilitation program.
In general, regular follow-up with a physical therapist is necessary to adapt the rehabilitation program and optimize recovery. Most patients notice significant improvement within 3 to 6 months after the fracture.
Possible complications
After a fracture of the navicular bone, some after-effects may persist and impair quality of life. Chronic pain is the most common complication, sometimes occurring despite proper bone healing, making daily activities uncomfortable. It is important to be aware of the common post-operative complications to better anticipate them.
In addition, joint stiffness often occurs, especially in the case of a displaced fracture, encouraging the onset of foot osteoarthritis due to damage to the cartilage. Instability may also occur while walking, caused by ligament or tendon injuries, or by a loss of muscle tone in weakened joints, resulting in a feeling of giving way.
The risk of osteoarthritis is also a frequent outcome, given the essential role of the navicular bone in the mobility and stability of the ankle and foot. This joint degeneration may result in a gradual loss of function, making everyday actions more difficult and limiting autonomy.
It is usually associated with persistent pain requiring regular medical monitoring, and may reduce the ability to engage in certain physical or sports activities, directly affecting well-being and quality of life.
FAQ about navicular bone fracture of the foot
The healing time for a navicular bone fracture can vary depending on several factors, such as the characteristics of the fracture and the type of treatment chosen. Here are some general guidelines:
- A navicular fracture is stable at 3 months, allowing for the resumption of activities and non-impact sports.
- The navicular is strong at 6 months, permitting all sports activities.
It is important to be aware of the complications that can arise after a navicular bone fracture. These may include:
- Chronic pain in the ankle and foot
- Joint stiffness, mainly felt on uneven ground.
- Post-traumatic osteoarthritis, which is more or less frequent depending on the initial characteristics of the fracture.
Preventing a navicular bone fracture can be achieved through a few simple measures:
- Strengthen your muscles: By doing targeted exercises for the muscles of the foot and ankle, you will improve your stability.
- Choose the right equipment: Opt for appropriate shoes, especially during sports activities, to reduce the risk of injury.
- Stay vigilant: Pay attention in risky environments, such as uneven terrain, and use safe techniques during your physical activities.
The management of a navicular bone fracture in the foot is important for the future function of the ankle and foot. Treatment adapted to the type of fracture and the patient's lifestyle, whether orthopedic or surgical, can greatly influence functional recovery. In case of a navicular fracture, the opinion of a specialist in ankle and foot pathologies is necessary.