A navicular stress fracture is a break in the navicular bone located in the midfoot. Stress fractures occur when a bone is subjected to repetitive stress in a relatively short period of time. For athletes, a navicular stress fracture can be a very frustrating and debilitating injury. Stress fractures are a common injury to athletes and are becoming more prevalent. The stress fracture most commonly occurs in high-impact sports such as running, basketball and soccer.
There are a number of different theories as to why navicular stress fractures occur. The common denominator to all these theories is the fact that navicular stress fractures occur in the presence of altered biomechanics. Two of the primary factors which are implicated in the development of stress fractures of the navicular are repetitive high-impact stress (i.e. running, jumping, and twisting) and inadequate time to recover after intense periods of athletic training. When an athlete runs, jumps or pivots, his feet are subject to repetitive force. These forces are transmitted directly to the navicular bone in the foot, and unless there is sufficient time to recover between periods of high-impact activity, the navicular bone can develop stress fractures due to overloading of the bone. This is referred to as overtraining.
In addition to overtraining, poor quality or inadequate footwear can also lead to navicular stress fractures. The incorrect support, cushioning or lack of stability provided by the shoe can cause an increase in stress on the navicular bone. Training in old, ill-fitting or poorly maintained shoes can lead to the navicular bone absorbing more shock during sporting tasks. As Patel et al. ( 2021) pointed out, the increasing incidence of this type of injury in particular sports suggests that more awareness is required among athletes and coaches regarding the selection of suitable shoe types.
The Navicular Stress Fracture is becoming easier to identify with the growing knowledge of the pathology. It is important to catch the symptoms early in the progression to a full stress fracture. The general symptoms of a navicular stress fracture are: midfoot pain in the navicular area pain and swelling in the navicular area pain to palpitation in the navicular area pain when bearing weight and more pain when weight bearing with activity and pain decreases when taking time to rest and recover. It is also important to diagnose and treat a navicular stress fracture as soon as possible to prevent chronic symptoms and prevent the need for possible surgery. A navicular stress fracture can become much more complicated and the athlete can be sidelined for an even longer period of time if the injury is left untreated.
To prevent navicular stress fractures, there are steps which can be taken to reduce the risk, especially in at risk populations. It is important to train the athlete correctly, educate them on the importance of rest days, and to listen to their body. The coach must progress the training load of the athlete in a suitable fashion to allow time for adaptation without loading the foot excessively. Proper footwear for the given sport should also be available to the athlete.
Navicular Stress Fractures are an increasingly common problem in athletes. Given their severity, it is important to look into the possible causes of navicular stress fractures, and their signs and prevention methods. Overall, this is a very important concern for athletes participating in high-stress sports, and knowledge of the navicular stress fracture and its various aspects is crucial for the health and performance of athletes. Overall, navicular stress fractures are a serious concern for athletes, and identifying any signs and symptoms is crucial in treating and managing stress fractures. Mainly, the common sign and symptom of a navicular stress fracture is tenderness at the top of the foot over the navicular bone. Athletes with navicular stress fractures often complain of foot pain that worsens with activity and describe the pain as sharp or dull. Symptoms can lead to a significant decrease in athletic performance as many athletes will choose to “work through the pain” instead of seeking adequate medical care. As stated by Gross and Nunley (2015) and seen in Figure 5, the decrease in athletic performance has a detrimental effect on the athlete’s foot function and health.
Diagnosing a navicular stress fracture can be very difficult. This is made more complicated with a clinical examination that is undertaken by a physician to assess and evaluate the location and nature of the pain and any swelling. A proper diagnosis is essential because the navicular stress fracture can easily be mimicked by many other conditions of the foot. As Younis et al. ( 2025) observed, ”Imaging studies, such as X-rays, MRI and CT scans, are essential for diagnosing navicular stress fractures. X-rays are not always accurate and stress fractures may be missed, and therefore the MRI or CT scan is often needed to confirm a diagnosis. Differential diagnosis is also very important to ensure that the navicular stress fracture is not being mimicked by another condition that may also have tendonitis or bursitis.
Stress fractures in the navicular bone can have a big impact on performance and mental state. There is a certain stereotype of athletes – that they are a bunch of competitive, high-achieving people who tend to love pushing themselves to extreme limits. Having a stress fracture therefore feels particularly foul. The research by Attia et al. ( 2021) found that the athlete’s sense of time spent in a disappointing return to sport (RTS) was increased when there was a longer delay prior to being diagnosed. Therefore even more stress, anxiety and fear can be introduced into the return to sport experience, creating potentially negative spirals that make recovery even more difficult.
Prevalence and impact of chronic injuries are difficult to quantify, however it is often misunderstood how much an acute injury can affect a person’s mental wellbeing. An athlete suffering from a chronic injury may often feel withdrawn as they are unable to train and participate with their team mates and in match play. In addition the athlete may feel forced to return to competition too soon as there is pressure from themselves and from others, thereby increasing the risk of another injury, particularly in high-risk groups such as runners, basketball players and dancers. It is important that symptoms of a chronic injury are identified and the diagnosis confirmed to ensure effective and appropriate management and treatment, therefore empowering the athlete to prevent further injury.
In conclusion, it is important for individuals to be aware of the signs and symptoms of navicular stress fractures, how they are diagnosed and also how they can affect performance and mental health. Athletes with a navicular stress fracture should be directed to appropriate care and education in order to have a successful rehabilitation experience. A navicular stress fracture diagnosed athlete will have a variety of treatment options based on the severity of the fracture and/or physician recommendation. Most common methods of treatment are conservative and/or surgical. Conservative methods involve the athlete’s foot being rested, and they are instructed to avoid activities that cause stress to the foot. The affected foot is placed in a non-weight bearing position and the athlete is put on crutches. The fractured navicular has enough time to heal while the bone and surrounding soft tissue recovers. Torg et al. (2010) state that physical therapy is also an important part of the rehabilitation process and that the soft tissue surrounding the foot needs to be strengthened and stretched.
When conservative management is not effective or when the fracture is significantly displaced surgical management may be required. This can involve an internal fixation procedure where plates and/or screws are required to hold the fracture in place. This can get the athlete back to competition more quickly then having to take an extended period of time for conservative management (Nunley et al., 2022). In all cases of fracture management the athlete should be considered on an individual basis and the best management based on the type of sport they participate in, their level of competition and their medical history.
In addition to management, prevention of navicular stress fractures is important for the management of this condition and particularly for high risk groups such as runners, dancers and military recruits. Appropriate training techniques should be used. Gradual increase in the intensity and amount of the training works towards in diminishing the risk of navicular stress fractures. A well structured training programme with periods of rest and convalescence is advised.
Wear proper footwear for sport activities. Appropriate athletic footwear for the activity may help to dissipate some of the forces that contribute to navicular stress fracture (Hawkins et al, 1994, McInnis & Ramey, 2016). Additionally, adequate support and cushioning of the foot may reduce the stress on the bone. Finally, footwear should be replaced frequently if it is damaged or excessively worn. Orthotics such as customized insoles for the shoes may also be beneficial to ensure proper foot biomechanics.
Cross-training is also helpful. With so many different types of exercises that can work different muscle groups in the body, cross-training can actually help to prevent overuse injuries to a single area. For example, if a runner develops aching in their feet, swimming or biking may be incorporated into the fitness program to work the body without damaging the feet.
Coaches and sports medicine teams have an important role to play in the prevention of stress injuries. Young athletes need to be made aware of the risks and given appropriate advice on how to avoid stress injuries. Coaches need to be aware of how much load a player is carrying and ensure that there is enough time for recovery in between efforts. Adequate nutrition and bio-mechanical techniques should also be checked. Communication with sports medicine teams will ensure that any problems such as pain are addressed promptly.
All three of the above (coaches, athletes and medical staff) need to stay up to date in the field of sports medicine in relation to stress fractures and injury prevention. They must be knowledgeable about the most recent research in this field to be able to deal with navicular stress fractures effectively and reduce the occurrence of stress fractures and general injury in athletes. Awareness and prevention are key elements in achieving this goal and as a result maintaining high level of fitness in athletes.
Citations:
Patel, K.A., Christopher, Z.K., Drakos, M.C. and O’Malley, M.J., 2021. Navicular stress fractures. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 29(4), pp.148-157. https://journals.lww.com/jaaos/fulltext/2021/02150/navicular_stress_fractures.2.aspx?context=featuredarticles
Attia, A.K., Mahmoud, K., Bariteau, J., Labib, S.A., DiGiovanni, C.W. and D’Hooghe, P., 2021. Return to sport following navicular stress fracture: a systematic review and meta-analysis of three hundred and fifteen fractures. International Orthopaedics, 45(10), pp.2699-2710. https://link.springer.com/article/10.1007/s00264-021-05147-6
Younis, Z., Ravi, B., Rezk, K., Shah, J. and Hamid, M.A., 2025. Navicular Stress Fractures: A Narrative Review of Pathoanatomy, Diagnostic Pitfalls, and Management. Cureus, 17(11). https://www.cureus.com/articles/430020-navicular-stress-fractures-a-narrative-review-of-pathoanatomy-diagnostic-pitfalls-and-management.pdf
Gross, C.E. and Nunley, J.A., 2015. Navicular stress fractures. Foot & Ankle International, 36(9), pp.1117-1122. https://journals.sagepub.com/doi/abs/10.1177/1071100715600495
McInnis, K.C. and Ramey, L.N., 2016. High-risk stress fractures: diagnosis and management. Pm&r, 8(3), pp.S113-S124. https://www.sciencedirect.com/science/article/pii/S1934148215010278
Torg, J.S., Moyer, J., Gaughan, J.P. and Boden, B.P., 2010. Management of tarsal navicular stress fractures: conservative versus surgical treatment: a meta-analysis. The American journal of sports medicine, 38(5), pp.1048-1053. https://journals.sagepub.com/doi/abs/10.1177/0363546509355408
Shakked, R.J., Walters, E.E. and O’Malley, M.J., 2017. Tarsal navicular stress fractures. Current reviews in musculoskeletal medicine, 10(1), pp.122-130. https://link.springer.com/article/10.1007/s12178-017-9392-9
Pegrum, J., Dixit, V., Padhiar, N. and Nugent, I., 2014. The pathophysiology, diagnosis, and management of foot stress fractures. The Physician and sportsmedicine, 42(4), pp.87-99. https://www.tandfonline.com/doi/abs/10.3810/psm.2014.11.2095
Nunley, J.A., Green, C., Morash, J. and Easley, M.E., 2022. Treatment of navicular stress fractures with an algorithmic approach. Foot & Ankle International, 43(1), pp.12-20. https://journals.sagepub.com/doi/abs/10.1177/10711007211034812
Monteagudo, M. and Martínez-de-Albornoz, P., 2022. Navicular fracture. Foot and Ankle Clinics, 27(2), pp.457-474. https://www.foot.theclinics.com/article/S1083-7515(21)00166-2/abstract
University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger, dad.
