Navicular Stress Syndrome
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Introduction
The Navicular is an intermediate tarsal bone on the medial side of the foot[1]. Its name (os navicular pedis; scaphoid bone) derives from the human bone's resemblance to a small boat. It articulates with four bones: the talus and the three cuneiforms; occasionally with a fifth, the cuboid.
While rare in the general population, stress fractures of the tarsal navicular bone are frequently incurred by professional athletes.[2]
Clinically Relevant Anatomy
The navicular unique anatomic location subjects it to medial and lateral compression forces from the first and second meta-tarso-cuneiform joints, respectively[3]. While the medial forces are shared with the talar head, the lateral forces are borne by the navicular alone. As a result of this unequal distribution of forces, navicular bone, which is covered by cartilage and has limited blood supply, especially in its central region, is more vulnerable to repetitive stress. This reduced blood flow increases the risk of damage under excessive force, potentially leading to breakdown or injury[4]., maximum shear stress is concentrated at the central third of the bone[5][6]. Moreover, contraction of the tibialis posterior tendon, which inserts on the navicular medial tuberosity elevates the medial stress experienced by the navicular[3]. With repeated compression of the navicular such as during running, the majority of forces are concentrated at the centre of the bone, causing the navicular to be repeatedly “bent” at the avascular zone[7][8].
risk factors
Running/jumping sports (for example: basketball) and similar activities.
Sudden increased exercise rate.
Walking after a period of inactivity.
treatment
Nonoperative: cast immobilization.
Operative: fragment excision.
[4]Both required physiotherapy.
References
- ↑ D.Richard, V.Wayne, M. Adam, Gray’s Anatomy for Students. Spain: Elsevier Publishers, 2005
- ↑ Shakked RJ, Walters EE, O’Malley MJ. Tarsal navicular stress fractures. Current reviews in musculoskeletal medicine. 2017 Mar 1;10(1):122-30.
- ↑ 3.0 3.1 Gross CE, Nunley JA. Navicular stress fractures. Foot Ankle Int. 2015 Sep;36(9):1117-22.
- ↑ 4.0 4.1 Johnson M. Stress fractures of the foot. Clin Sports Med. 2015 Oct;34(4):769-90. Nickel FR, Ahuero J, Ahmad J.
- ↑ Hossain M, Clutton J, Ridgewell M, Lyons K, Perera A. Stress fractures of the foot. Clin Sports Med. 2015 Oct;34(4):769-90.
- ↑ McInnis KC, Ramey LN. High-risk stress fractures: diagnosis and management. PM R. 2016 Mar;8(3 Suppl)
- ↑ Mann G, Hetsroni I, Constantini N, Dolev E, Palmanovich E, Finsterbush A, et al. Navicular stress fractures of the foot. Sports Injuries: Prevention, Diagnosis, Treatment and Rehabilitation. 2015:1-2.
- ↑ Bennell K, Matheson G, Meeuwisse W, Brukner P. Risk factors for stress fractures. Sports medicine. 1999 Aug 1;28(2):91-122.