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Navicular Stress Fracture
A high index of suspicion for navicular stress fracture is of paramount importance in its diagnosis in the athlete. Delay in diagnosis between 1 and 7 months has been described and is often ascribed to the pain seemingly originating from the ankle. Obtaining a thorough history and physical examination is the first step in making the diagnosis. Insidious midfoot pain during sport or activity, particularly sprinting, jumping, and pushing off, is an important early finding. A distinction should be made between overuse syndromes, which typically cause more pain after activity, and stress fractures, which cause more pain during activity. Vague foot pain in the dorsolateral longitudinal arch also may be the initial complaint. The athletic patient should be questioned about changes in training, such as recent increases in intensity or duration or a change of equipment or technique, any of which can be a source of stress fracture. This chapter reviews the indications, contraindications, and surgical steps for managing patients with navicular stress fractures. Outcomes, alternative treatments, and potential complications of surgery are also discussed.