Athletes typically have vague midfoot pain just beyond the ankle. The pain typically hurts most during and just after athletic activity and resolves with a period of rest. In more severe cases, patients may even have pain with more routine activities such as walking. There is usually no history of an acute injury, rather most athletes describe a worsening, nagging pain. Unfortunately, this often leads to a delay in diagnosis, and while it usually causes no long-term problems, it does delay the start of treatment.
Diagnosis of a navicular stress fracture is suspected when athletes have pain directly over the navicular bone. There may be a small degree of swelling in the area. Sometimes the navicular stress fracture is seen on x-ray, but often requires a bone scan to be seen. CT scans are also helpful to better identify the fracture pattern and to evaluate for healing. Treatment of a navicular stress fracture is with a short-leg cast and crutches. Usually six weeks in a cast is sufficient, but some patients may require longer. In a small group of patients, the navicular stress fracture will not heal and may require surgery. Conservative treatment, however, is most often effective.