-Case Reports-

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

Kazumasa Abe¹, Hiroshi Hashiguchi¹, Kentaro Sonoki¹, Satoshi Iwashita² and Shinro Takai²

¹Department of Orthopedic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
²Department of Orthopedic Surgery, Nippon Medical School Hospital, Tokyo, Japan

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.

J Nippon Med Sch 2019; 86: 122-125

Keywords
stress fracture, tarsal navicular bone, athlete, refractory, conservative treatment

Correspondence to
Kazumasa Abe, MD, Department of Orthopedic Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba 270-1394, Japan
kazumasa@nms.ac.jp

Received, April 10, 2018
Accepted, October 17, 2018