The patient presents with symptoms and imaging studies consistent with a navicular stress fracture. Initial mangement of these injuries consists of non weight bearing cast immobilization.
Khan et al found that patients managed with a minimum of 6 weeks of non weight bearing (NWB) had significantly improved rates of return to sport (86%) compared with patients that were allowed to weight bear as tolerated (26%). After failure of weight bearing management, 6/7 patients who were then NWB in a cast were able to return to sports.
Lee et al review the clinical presentation, evaluation, and treatment of navicular stress fractures. The authors advocate for initial management with NWB immobilization and note that CT and MRI may be useful to determine the chronicity of the injury.
Torg et al performed a meta-analysis of the existing literature regarding treatment of navicular stress fractures. The authors note that no difference has been seen in patient outcomes between NWB and operative management and they state that NWB cast immobilization should be the initial treatment for navicular stress fractures.
Answer 1: Weight bearing as tolerated in a hard soled shoe is less effective than NWB cast immobilization for navicular stress fractures
Answer 3: Fragment excision and tendon advancement is not a described technique to manage these injuries
Answer 4: Percutaneous screw fixation may be indicated after failure of 6-8 weeks of non weight bearing
Answer 5: Open reduction, with or without bone grafting, is not the preferred initial management
Khan KM, Fuller PJ, Brukner PD, Kearney C, Burry HC. Outcome of conservative and surgical management of navicular stress fracture in athletes. Eighty-six cases proven with computerized tomography. Am J Sports Med. 1992 Nov-Dec;20(6):657-66.
PMID:1456359 (Link to Abstract)
Lee S, Anderson RB. Stress fractures of the tarsal navicular. Foot Ankle Clin. 2004 Mar;9(1):85-104
PMID:15062216 (Link to Abstract)
Torg JS, Moyer J, Gaughan JP, Boden BP. Management of tarsal navicular stress fractures: conservative versus surgical treatment: a meta-analysis. Am J Sports Med. 2010 May;38(5):1048-53
PMID:20197494 (Link to Abstract)