Stress fractures of the tarsal navicular. A retrospective review of twenty-one cases.

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Abstract
In a multi-institutional study, 21 stress fractures of the tarsal navicular bone were analyzed in 19 patients with particular reference to the clinical and radiographic characteristics, the results of treatment and the complications associated with the fracture. Microangiographic studies were done on 5 fresh human cadaver specimens to determine the vascular patterns peculiar to the tarsal navicular bone. The fractures occurred predominantly in young male athletes (mean age, 21.8 yr). Because routine radiographs failed to show the fracture, or showed it but it was not recognized, the interval between the onset of symptoms and diagnosis ranged from less than 1 mo. to 38 mo. (mean interval, 7.2 mo.). For 14 of the 21 lesions, radionuclide bone scans were needed to locate the abnormality in the tarsal navicular and for 17, anteroposterior tomograms made with the dorsum of the foot parallel to the tomographic cut were needed to confirm the diagnosis of fracture (in 14) or to evaluate further the stage of healing (in 3). The characteristic fracture was oriented in the sagittal plane and located in the central 1/3 of the bone, and was either partial or complete. Initially, 19 fractures were treated conservatively and 2 were treated surgically. Treatment included immobilization in a non-weight-bearing cast for 6-8 wk for 10 fractures; immobilization in a weight-bearing cast for 4; limitation of activity with continued weight-bearing for 5; open reduction and internal fixation for 1 acute displaced fracture; and an autogenous bone graft for 1 non-union. All 10 fractures that were initially treated in non-weight-bearing casts healed without complications. Of the 9 patients whose fractures were treated by limitation of activity but continued weight-bearing or by immobilization in a weight-bearing cast, 7 were unable to resume vigorous activity after that treatment because of pain associated with delayed union, non-union, or recurrence of the fracture.

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