What is Tarsal Navicular Fracture

Tarsal navicular fracture is a break in a bone in the top middle area of the foot. The group of bones in the feet are called the tarsal bones. The navicular bone is wedged between other tarsal bones.

Tarsal navicular fractures occur most often in athletes because running and jumping put a lot of pressure on the navicular bone.

What are the causes?

This condition may be caused by:

• Severe twisting of the foot.
• Something heavy falling on the foot.
• Wear and tear on the bone from the foot striking the ground repeatedly (stress fracture).

What increases the risk?

You may be more likely to develop this condition if you:

• Do high-impact activities, such as:
  • Track and field.
  • Football.
  • Soccer.
  • Basketball.
  • Gymnastics.
  • Ballet dancing.
• Are a female who has an irregular menstrual cycle.
• Have a condition that causes your bones to become thin and brittle (osteoporosis).
• Smoke.
• Start a new sport without being in good shape.
• Wear athletic shoes that do not fit well.

What are the signs or symptoms?

Symptoms may include:

• Swelling on the top of your foot.
• Pain at the top of your foot. The pain may move down into the arch of your foot.
• Pain when pressing on the top of your foot.
• Pain when hopping on your foot.
• Pain that gets worse with activity and better with rest.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Any recent foot injuries you have had.
• A physical exam.
• An X-ray of your foot. If you have a stress fracture, it may not show up on an X-ray, and you may need other imaging tests, such as:
  • A bone scan.
  • CT scan.
  • MRI.

How is this treated?

Treatment depends on how severe your fracture is and how the pieces of the broken bone line up with each other (alignment).

• If your broken bone is in good alignment, you will need to wear a cast or splint for at least 6 weeks. While wearing the cast or splint, you will not be able to put any weight on your foot. You will be given crutches.
• If your fracture is severe and the broken bone is not aligned (is displaced), you may need surgery to align the fracture (open reduction and internal fixation, ORIF). This is rare. During surgery, the bone pieces are fixed into place with metal screws or pins.

Treatment will also include having follow-up visits with your health care provider to make sure you are healing.

Follow these instructions at home:

If you have a splint:

• Wear the splint as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the splint if your toes tingle, become numb, or turn cold and blue.
• Keep the splint clean and dry.

If you have a cast:

• Do not stick anything inside the cast to scratch your skin. Doing that increases your risk for infection.
• Check the skin around the cast every day. Tell your health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do not put lotion on the skin underneath the cast.
• Keep the cast clean and dry.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.
• If your splint or cast is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.

Activity

• Do not use your affected leg to support your body weight until your health care provider says that you can. Use crutches as directed.
• Ask your health care provider what activities are safe for you during recovery, and what activities you need to avoid.

Managing pain, stiffness, and swelling

• If directed, put ice on painful areas:
  • If you have a removable splint, remove it as told by your health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag, or between your cast and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) your lower leg above the level of your heart while you are sitting or lying down, when possible.

General instructions

• Do not put pressure on any part of the cast or splint until it is fully hardened, if applicable. This may take several hours.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive until your health care provider approves. You should not drive or use heavy machinery while taking prescription pain medicine.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you have:

• Pain that gets worse or does not get better with medicine.
• A fever.
• A bad smell coming from your cast or splint.

Get help right away if you have:

• Any of the following in your toes or your foot, even after loosening your splint (if applicable):
  • Numbness.
  • Tingling.
  • Coldness.
  • Blue skin.
• Redness or swelling that gets worse.
• Pain that suddenly becomes severe.

Summary

• A tarsal navicular fracture is a break in a bone in the top middle area of the foot.
• Tarsal navicular fractures occur most often in athletes because running and jumping put a lot of pressure on the navicular bone.
• Do not use your affected leg to support your body weight until your health care provider says that you can.
• Keep all follow-up visits as told by your health care provider. This is important.