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This Article Full Text Full Text (PDF) All Versions of this Article: 33/12/1875    most recent 0363546505278253v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by Burne, S. G. Articles by Khan, K. M. Search for Related Content PubMed PubMed Citation Articles by Burne, S. G. Articles by Khan, K. M. Related Collections Imaging Studies Fracture

Tarsal Navicular Stress Injury

Long-term Outcome and Clinicoradiological Correlation Using Both Computed Tomography and Magnetic Resonance Imaging

Scott G. Burne, MBBS, FACSP^*, Chris M. Mahoney, MD, FCRC, Bruce B. Forster, MSc, MD, FCRC, Michael S. Koehle, MD, MSc, Jack E. Taunton, MD, MSc and Karim M. Khan, MD, PhD^,||

From the ^* Department of Pharmacology and Physiology, University of New South Wales, Sydney, Australia, and the Department of Radiology, the Allan McGavin Sports Medicine Centre, and the Departments of Family Practice, Orthopaedics, and Human Kinetics, University of British Columbia, Vancouver, Canada

^|| Address correspondence to Karim M. Khan, MD, PhD, 2150 Western Parkway, Vancouver, Canada, V6T 1V6 (e-mail: kkhan{at}interchange.ubc.ca).

Background: Tarsal navicular stress fracture is a condition that has curtailed many athletic careers. Management protocols remain varied and somewhat controversial.

Hypotheses: (1) Clinical practice does not mirror the recommendations reported from previous case series. (2) Clinical outcome is poor when navicular stress fracture is managed in a variety of ways. (3) Imaging does not correlate strongly with clinical status at long-term follow-up after navicular stress fracture.

Study Design: Case series (prognosis); Level of evidence, 4.

Methods: From a computer registry, we identified patients who had attended a university sports medicine center between 1996 and 2002 and whose final diagnosis was navicular stress fracture (n = 11) or navicular stress reaction (n = 9). All patients had provided demographic and clinical data at their original evaluation, and all had undergone bone scans and computed tomographic imaging. These data were extracted by chart review. Follow-up clinical and imaging assessments took place a median of 3.7 years later (range, 1–15.7 years). At these assessments, we administered a questionnaire, performed a structured physician examination (blinded to other data), scanned both feet with computed tomography, and obtained magnetic resonance images of the affected foot.

Results: Only 2 of 11 patients (18%) with navicular stress fractures received the literature-recommended treatment of at least 6 weeks’ nonweightbearing cast immobilization. Of these 11 patients, only 6 (55%) returned to sports at their previous level. Only 3 patients with navicular stress fractures regained normal imaging appearance at follow-up. Pain score, stiffness, sporting success, current sporting involvement, and recurrence/time to recurrence were not statistically associated with computed tomographic or magnetic resonance imaging parameters. Of 9 patients with navicular stress reactions, 7 developed clinical and radiological features of navicular stress fracture, but 6 of 9 patients (67%) returned successfully to sports.

Conclusions: Contemporary management of navicular stress fracture differs from that recommended in the literature. This stress fracture prevented almost half of the participants in this study from returning to sports at their previous level. Imaging parameters do not correlate with the clinical assessment of a patient at long-term follow-up of navicular stress fracture.

Key Words: navicular stress fracture • magnetic resonance imaging (MRI) • computed tomography (CT) • navicular stress reaction

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