Review of Current Management of Navicular Stress Fractures in Athletes

Context: Navicular stress fractures are relatively uncommon injuries seen most frequently in high-level athletes due to repetitive compressive and shearing forces. The tenuous arterial network and central watershed area predispose the navicular to stress fractures and healing complications. Diagnosing these stress fractures can be difficult for Certified Athletic Trainers due to the ambiguous and insidious nature of these injuries. Identifying risk factors and clinical signs of navicular stress fractures is important to optimally treat these injuries. Intrinsic risk factors include female sex, characteristics of the “female athlete triad,” relative energy deficiency in sports, previous foot injury, and dietary insufficiencies. Historically, navicular stress fractures were managed conservatively with 6 weeks of protected nonweightbearing (NWB). Recent literature has found faster return to activity (RTA) and decreased complication rates with operative open reduction internal fixation (ORIF) for treating type 2 and type 3 injuries in high-level athletes. Evidence Acquisition: A retrospective review of PubMed/MEDLINE was performed to identify articles. We identified multiple key terms and phrases relevant to the topic being reviewed. In this review, key words include “navicular stress fracture,” “athlete,” “treatment,” “management,” “open reduction internal fixation,” and “return to activity.” Necessary filters or limits were applied to refine our search. Study Design: Retrospective review of recent literature exploring the management, and outcomes of navicular stress fractures in athletes. Level of Evidence: Level 2. Methods: Articles were screened to identify those with outcomes such as time to RTA and successful RTA after operative or nonoperative management of navicular stress fractures. Results: Recent literature demonstrated potential quicker RTA for operative treatment of type 2 and type 3 navicular stress fractures in the high level athletic population. Conclusion: ORIF is a reasonable treatment modality that should be considered with a low threshold in younger athletic patients performing at a high or professional level. Strength-of-Recommendation Taxonomy (SORT): B.