How to Heal a Broken Navicular Bone? (Foot Fracture)

Different names for a navicular fracture of the foot

As is often the case in medicine, we use lots of different words to talk about the same thing!

In this article I talk about

• navicular bone fractures
• scaphoid fractures of the foot
• tarsal scaphoid fracture

All these terms refer to the same fracture!

The most current term is “navicular bone”, but doctors and physiotherapists still often use the term “tarsal scaphoid” to designate this bone.

Here is where the scaphoid is located on the foot pictured (right foot):

And a diagram of the foot with the navicular bone in purple (right foot):

Finally, what does a fracture of the navicular bone look like on X-ray?

How can I be sure it’s a navicular fracture and not something else? (Symptoms)

The symptoms of a navicular bone fracture are similar to those of other foot problems that can occur following a shock or accident : simple contusion, sprain, tendonitis, fracture of another bone in the foot.

These are the symptoms:

• significant pain in the forefoot even without doing anything;
• difficulty walking, putting foot on the ground, because of pain ;
• your foot is swollen, in the forefoot or the whole foot, and even the leg;
• a bruise appears on the forefoot or ankle.

The mode of onset of these symptoms also helps in making the diagnosis:

• scaphoid fractures occur mainly in road accidents, but also in the aftermath of falls;
• it’s also a bone that breaks due to repeated micro-trauma, for example when you do a lot of competitive sports like gymnastics or running. In this case, we speak of a fatigue fracture.

To be sure the bone is broken, and to see exactly what the fracture is (whether it’s displaced or not), your doctors have probably taken an X-ray of the foot.

The X-ray allows you to visualize the scaphoid and see if there is a fracture. In case of doubt, a CT scan is sometimes performed. These 2 examinations allow you to be almost certain of not missing a fracture.

What is the usual treatment for navicular fractures in the foot?

As with most fractures, there are 2 main types of treatment for a navicular fracture:

• conservative treatment: no operation, but instructions for immobilization or less weight-bearing, and a follow-up appointment;
• surgical treatment (less frequent): operation.

Is it necessary to immobilize the navicular bone?

The foot is usually partially immobilized after a navicular bone fracture. For example, with a small cast, or a walking boot.

The immobilization is partial, because given its location, it’s quite difficult to immobilize this bone!

Immobilization in a cast or boot is often recommended for 6-8 weeks, until a follow-up X-ray is taken. The walking boot can be removed for sleeping and bathing.

Are we allowed to walk and stand on our feet?

There are many different approaches to resuming walking after a scaphoid fracture. Depending on your fracture, your state of health, but also the healthcare professionals (surgeons, doctors, physiotherapists) you come across!

In all cases, walking is possible without support or with partial support : this is known as total or partial discharge walking. Sometimes, full support is allowed from the outset.

Sometimes, therefore, you’re allowed to walk “normally” right from the start, putting as much weight on your foot as you like, depending on the pain. But you’ll probably need crutches to relieve the pressure.

I have made free-access guides on this very subject, with photos and videos:

• How do you resume walking on crutches after a period without support?
• How to walk with crutches, then get rid of them after a fracture

How do you know what’s okay in your case?

Normally, this is written down somewhere in your examination or emergency room report. Or you’ve been told verbally.

If you haven’t been told about this, it’s probably because you’re allowed to walk, and it’s just a matter of feeling it out! Of course, you can also discuss this with your physio or GP.

Do I need physiotherapy?

It’s not uncommon to need physiotherapy after a navicular fracture. These are prescribed either as soon as the fracture is diagnosed, or after a follow-up X-ray and a period without weight-bearing.

The aim of the physiotherapy sessions is to help you gradually resume all your previous activities!

To achieve this, it is sometimes necessary to :

• regain some mobility and flexibility in the forefoot. Through exercises and self-mobilization ;
• regain muscle strength in the foot and leg muscles. Here again, exercises are sometimes suggested. But the simple fact of gradually resuming walking, stair climbing and all your daily activities may be enough (depending on the context);
• relieve your pain.

If you feel that you can get back to your everyday activities on your own, without having to ask any questions, that’s great! In that case, you can probably get by with self-rehabilitation.

If you haven’t been prescribed a physiotherapy session, but you’re feeling lost, you can discuss this with your GP, who can prescribe a physiotherapy session.

Why is there sometimes an operation?

If you’ve had surgery, it’s because your surgeon felt that your type of fracture, your state of health and your lifestyle meant that you would recover better with surgery than without.

Sometimes surgeons will involve you in the decision to operate or not, because there’s always a balance to be made between the benefits and the risks.

The operation stabilizes the fracture (= prevents it from moving) to promote bone consolidation. With hardware such as a plate or screws.

This does not mean, however, that you do not need to take the same precautions for a gradual resumption of activity, as if you had not undergone surgery.

How long does it take to heal and consolidate a navicular fracture in the foot?

Rest assured: fractures of the navicular bone generally recover well.

The consolidation time is fairly standard: it takes between 6 and 8 weeks for the bone to begin to consolidate properly. That’s why you’ll often have a follow-up X-ray at that point.

Here are some typical recovery data:

	Usual lead times
Bone consolidation	6-8 weeks
Disappearance of edema (swelling of the foot)	Several weeks to several months
Resuming walking with crutches without support or with contact support	Immediately
Resuming walking with support	6 weeks – sometimes immediately
Back to work	1-4 months
Back to sport	2-6 months
Total functional and muscular recovery	4 months – 1 year

Here are some data from studies that track people’s recovery from navicular bone fractures (Gheewala 2023):

• In one study, 57 of 62 injured patients were able to return to 100% of their previous activity in the months following the navicular fracture;
• in another study which followed 10 people with very severe navicular fractures (= comminuted fracture = bone broken in several places), 100% consolidated well. And in the 20-month follow-up, none of them required revision surgery with arthrodesis.

As with any fracture, complications are possible, but they are the exception rather than the rule: stiffness, residual pain, non-union fracture) or necrosis of the bone.

Can you work with a navicular fracture?

Of course, this depends a lot on your professional activity: do you spend a lot of time on your feet?

The French National Health Insurance (Assurance maladie) issues guides with typical lengths of time off work depending on the type of fracture, but says nothing about navicular fractures (probably because they are not very common).

In general, you should expect to be off work for between 3/4 weeks and 3/4 months (or even longer), depending on your job and how you recover.

Some people pick up right away, adapting what they do and where they go, while others (a minority) need even longer).

***

I hope I’ve answered most of your questions! If you have any others, or if you’d like to share your experience, please feel free to comment!

• Resuming walking without crutches after a fracture
• Can you drive with a fracture, a walking boot or a cast?

📚 SOURCES

Gheewala R, Arain A, Rosenbaum AJ. Tarsal Navicular Fractures. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542221/

Length of time off work on ameli.fr (nothing specific about navicular bones)

Image: Ahmed A, Westrick E. Management of Midfoot Fractures and Dislocations. Curr Rev Musculoskelet Med. 2018 Dec;11(4):529-536. doi: 10.1007/s12178-018-9518-8. PMID: 30196386; PMCID: PMC6220014.