Can you skip a diagnostic test for an injury and just start treatment assuming that’s the problem? In this week’s Ask Dr. Geier video, I answer that question from a reader who feels he has a navicular stress fracture in his foot.
From all the symptoms described, I feel that I have a navicular stress fracture. The doctor I saw recommended a bone scan. However, I am concerned about the procedure of injecting radioactive dye into my body. Can I just treat the foot pain as a stress fracture and go right for the medical boot to wear and see how it feels after a few weeks of wearing the boot? Since the boot is a treatment for a stress fracture, what do you think about proceeding with treatment without the bone scan?
Of all the stress fractures that can occur in the lower extremities of athletes, one of the least common, but unfortunately most serious, is a stress fracture of the navicular. This is a bone in the midfoot toward the inside of the foot. Stress fractures of the navicular occur in running and jumping athletes, such as basketball players.
Sports medicine physicians who examine these athletes will note tenderness to palpation on the inside of the midfoot, but sometimes the pain can be somewhat diffuse. A high index of suspicion is needed to avoid missing this injury. Early on in the process x-rays can be negative, so a bone scan or MRI might be performed.
Navicular stress fractures can be serious injuries. As with most stress fractures of other parts of the body, treatment is often nonsurgical. Unlike most stress fractures, however, sports medicine physicians are usually very careful with this injury, and I almost always place these athletes in a cast.
I’m very concerned with the possibility of the fracture not healing, so I will even keep the athlete from putting weight on it until the fracture heals. Many surgeons even advocate surgical treatment, especially in high-level athletes. If the fracture does not heal, surgery to put bone graft in the fracture and hold it in place with one or two screws is indicated.
In this video, I explain when bone scans or MRIs are helpful to diagnose navicular stress fractures and how we treat these injuries if we find them.
Navicular Stress Fractures