Numerous patients experience this sort of injury living an active lifestyle in Naples Florida.
Recently, Ben Roethlesberger of the Pittsburg Steelers also suffered a similar injury (although not confirmed by the Steelers), and he may need some time off his foot to sufficiently heal his injury. We see a number of patients who will have the vague symptoms of pain after activity in the medial aspect of the rearfoot area, which will not show anything on regular xrays. After 3 months, most doctors will refer to us for further workup. We usually will obtain more advanced study such as CT or MRI, and depending on what it shows, treatment ensues. This is one of the latest articles regarding this topic, which in short, demonstrates how a minimally displaced fracture may still require screw fixation in select cases to adequately relieve symptoms and ensure return to sporting activity in a reasonable timeline.
Published in: Journal of Foot & Ankle Surgery, March/April, 2000
Amol Saxena, DPM
22 Navicular Stress Fractures sustained during athletic activity were retrospectively reviewed for return to activity time and the appearance of fracture pattern on Computerized Tomography. Average follow-up was 36.5 months. There were 10 females and nine males, with the average patient age being 27.2 years. Three patients sustained bilateral injuries at separate times.
Nine patients underwent open reduction, internal fixation (some with bone grafting); this group’s average return to activity (RTA) was 3.1 +1.2 months (range = 1.5-5 mos). Thirteen patients treated conservatively had an average return to activity of 4.3 +2.8months (range = 2 –13 months). The difference between the two groups’ RTA was significant (P=.02). Eleven patients utilized Pulsed Electromagnetic Fields and had an average RTA of 4.2 +3.4 months with three patients also having surgery. (The latter three patients had the fastest RTA at 3.0 months.) Two conservatively treated fractures that eventually took five and eight months to RTA, respectively, re-fractured during the treatment process.
Retrospective review showed CT fracture patterns in the frontal plane classified as: Dorsal cortical break (Type I), fracture propagation into the navicular body (Type II), and fracture propagation into another cortex (Type III). This is proposed as a classification system and is to include modifiers "A" (Avascular Necrosis of a portion of the navicular),"C" (Cystic changes of the fracture), and "S" (sclerosis of the margins of the fracture), the latter of which was most common in our series, particularly in continually symptomatic patients. Type I fractures were more likely to receive conservative treatment (P = .02) and Type III fractures took significantly longer to heal than Types I and II, (P values .001 and .01, respectively.) Type I and II injuries had an average RTA of 3.0 and 3.6 months, respectively. Type III injuries had an average RTA of 6.8 months. Based on our findings we recommend surgery for patients with these modifiers, particularly with Type II and III injuries.
Amol Saxena, DPM
22 Navicular Stress Fractures sustained during athletic activity were retrospectively reviewed for return to activity time and the appearance of fracture pattern on Computerized Tomography. Average follow-up was 36.5 months. There were 10 females and nine males, with the average patient age being 27.2 years. Three patients sustained bilateral injuries at separate times.
Nine patients underwent open reduction, internal fixation (some with bone grafting); this group’s average return to activity (RTA) was 3.1 +1.2 months (range = 1.5-5 mos). Thirteen patients treated conservatively had an average return to activity of 4.3 +2.8months (range = 2 –13 months). The difference between the two groups’ RTA was significant (P=.02). Eleven patients utilized Pulsed Electromagnetic Fields and had an average RTA of 4.2 +3.4 months with three patients also having surgery. (The latter three patients had the fastest RTA at 3.0 months.) Two conservatively treated fractures that eventually took five and eight months to RTA, respectively, re-fractured during the treatment process.
Retrospective review showed CT fracture patterns in the frontal plane classified as: Dorsal cortical break (Type I), fracture propagation into the navicular body (Type II), and fracture propagation into another cortex (Type III). This is proposed as a classification system and is to include modifiers "A" (Avascular Necrosis of a portion of the navicular),"C" (Cystic changes of the fracture), and "S" (sclerosis of the margins of the fracture), the latter of which was most common in our series, particularly in continually symptomatic patients. Type I fractures were more likely to receive conservative treatment (P = .02) and Type III fractures took significantly longer to heal than Types I and II, (P values .001 and .01, respectively.) Type I and II injuries had an average RTA of 3.0 and 3.6 months, respectively. Type III injuries had an average RTA of 6.8 months. Based on our findings we recommend surgery for patients with these modifiers, particularly with Type II and III injuries.
Conservative treatment may be prolonged, and requires at least 6 weeks of non-weight bearing in a below knee cast/boot to be successful.
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