Ace Physiotherapy and Sports in Singapore
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ACE PHYSIO SPORTS
East gate Building, 46 East Coast Road
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Sunday (By prior appointment)
Stress Fracture of the Navicular
What is a stress fracture of the navicular?
The navicular is a bone located at the highest point of the arch of the foot. A navicular stress fracture is a small crack or incomplete fracture within this bone. Physiotherapy plays an important role in the treatment and rehabilitation of navicular stress fractures.
How does a stress fracture of the navicular happen?
Navicular stress fractures occur due to an imbalance between bone formation and bone resorption. High-impact weight-bearing activities such as running or dancing place increased stress on the navicular bone — which sits at the keystone of the foot's arch — leading to increased bone turnover. This bone remodeling is a natural adaptation to meet physical demands, but when bone breakdown occurs faster than bone repair, a stress fracture can develop.
When repetitive stress is placed on the navicular bone, small areas of the bone can become damaged. These damaged areas are then resorbed and replaced with new bone tissue. However, if new bone is formed more slowly than the old bone is removed, weak areas begin to develop. If these weak points continue to be stressed, they can eventually progress into a stress fracture of the navicular.
A recent change in training habits is often a contributing factor in the development of a navicular stress fracture. This may include changes in training frequency, duration, intensity, as well as changes in footwear or training surfaces.
What are the symptoms of a stress fracture of the navicular?
Navicular stress fractures often present with vague symptoms. The pain typically radiates along the arch of the foot immediately after sprinting or jumping. Unlike most other lower limb stress fractures, navicular stress fractures may cause pain in various areas of the foot, including the second and third toes, the outer border of the foot, the inner heel, and the inside of the arch. These symptom patterns occur due to the nerve supply distribution in the foot. Although the pain may lessen with rest and allow the person to resume running or jumping temporarily, it usually returns if the bone has not healed fully. Importantly, a reduction in pain at rest does not mean the fracture has healed. Additional symptoms may include:
- Localised tenderness when pressing over the top of the navicular bone (dorsal midfoot area)
- Swelling on the top or inner side of the foot
- Discomfort when standing on tiptoes or pushing off the foot
- Pain during hopping or jumping tests
- A “pinching” or sharp sensation felt during high-impact movements
- Occasional numbness or tingling in nearby toes due to nerve irritation
What should I do if I have a stress fracture of the navicular?
If you experience pain across the top, central, inner, or outer areas of the foot, you may have a navicular stress fracture. Because the navicular bone has a very poor blood supply, its ability to heal is reduced. If you suspect this type of stress fracture, you should visit your GP or your nearest accident and emergency department for further investigation.
What shouldn’t I do if I have a stress fracture of the navicular?
If you suspect a stress fracture of the navicular, you should stop exercising immediately. A stress fracture represents a weak area in the bone, and continuing activity could cause further damage — potentially leading to a full fracture.
Physiotherapy treatment following a stress fracture of the navicular.
In most cases of navicular stress fracture, non–weight-bearing in a cast is the preferred initial treatment. In some cases, surgery may also be required. After this initial management, a physiotherapist can devise a progressive exercise programme to support a safe return to activity. They will also assess the underlying causes of the stress fracture and address them during rehabilitation. Other treatment options may include:
- Controlled gradual weight-bearing progression once the fracture has started to heal and is cleared by a specialist
- Strengthening exercises for the foot, ankle, and lower limb to improve support and prevent re-injury
- Stretching exercises for the calf muscles and surrounding structures to reduce stress on the navicular bone
- Low-impact cross-training activities (e.g., cycling, swimming) to maintain cardiovascular fitness during recovery
- Manual therapy or joint mobilisation to address stiffness after immobilisation
- Gait retraining to correct foot mechanics and improve walking/running technique
- Orthotics or cushioning insoles to offload pressure from the navicular and support the arch
- Training and load management advice to prevent overuse and re-occurrence of stress fractures
Could there be any long-term effects from a stress fracture of the navicular?
The navicular bone has a poor blood supply, and fractures to this bone are well known for non-union (failure to heal). Early treatment greatly improves the long-term outlook. In some cases, surgery may be required to ensure the fracture fully unites and heals.
To arrange an appointment, please call +65 81535374 or visit acephysiosports.com.
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