Tarsal Navicular Stress Fracture in a Young Athlete: A Case Report

• Published in: Journal of Nippon Medical School Vol. 86; no. 2; pp. 122 - 125
• Main Authors: Abe, Kazumasa, Hashiguchi, Hiroshi, Sonoki, Kentaro, Iwashita, Satoshi, Takai, Shinro
• Format: Journal Article
• Language: English; Japanese
• Published: Japan The Medical Association of Nippon Medical School 26.04.2019
• Subjects: athlete; conservative treatment; refractory; stress fracture; tarsal navicular bone; refractory; stress fracture; conservative treatment; athlete; tarsal navicular bone
• ISSN: 1345-4676; 1347-3409
• DOI: 10.1272/jnms.JNMS.2019_86-208

Approximately 30% of tarsal navicular stress fractures are missed by physicians because plain radiographs often show no diagnostic clues. If early diagnosis and treatment are not obtained, such fractures will become refractory and the patient will no longer be able to actively participate as an athlete. We herein describe our experience treating a 14-year-old female track sprinter with persistent foot pain. Magnetic resonance imaging 6 months after the onset of pain showed a stress fracture of the tarsal navicular bone. Computed tomography showed the tarsal navicular stress fracture as well as sclerosis at the fracture edges. We diagnosed a refractory tarsal navicular stress fracture. Conservative management in the form of non-weight-bearing cast immobilization is the standard treatment for both partial and complete stress fractures of the tarsal navicular bone. However, surgical treatment is required in refractory cases. We treated the herein-described refractory case with 6 weeks of non-weight-bearing cast immobilization. We instructed the patient to perform quad muscle training at the same time as casting. Six weeks later, follow-up computed tomography showed callus formation and disappearance of the fracture line. The patient thus began full weight bearing with daily use of arch support equipment, and we allowed her to gradually return to sports. We gradually increased her activity intensity from jogging to running. She completely and successfully returned to sports after 3 months of treatment.