What are the top five navicular stress fracture mistakes I see in runners? Well, that is what we’re talking about today on the Doc On The Run Podcast.
The navicular bone is this little bone right here on the top of your foot. It is at the apex of your arch. It is right down in front of your ankle, and this is one of the most frightening things that I see in runners. It is not a good thing to break your navicular. It is sandwiched between four different bones, and it is very easy to get a crack that causes arthritis in any of the joints on either side of that bone and any of the arthritis or pain in that area could lead to serious interference with your ability to run.
You want to not make mistakes if you get a navicular stress fracture and when I see runners who have a navicular stress fracture the first thing, I will tell you this is not really one of the mistakes I thought of here. However, the first one is to not get a second opinion.
I just saw somebody yesterday who had a navicular stress fracture and she’s been in a boot for six weeks and isn’t doing better at all so far. She should have gotten a second opinion six weeks ago not yesterday, but you know what they say best time to plant a tree is a hundred years ago second-best time is today. If you get a navicular stress fracture, there are a few mistakes that I do see in these runners who call me for a second opinion that may have actually helped them improve faster.
The first one is relying on x-rays or MRI to determine the severity of the injury. I would not do that that is what’s most commonly done so what usually happens is you go into the doctor’s office they take x-rays of your foot, they don’t see anything, they tell you maybe you have a sprain maybe you have a stress reaction. They don’t really know here’s your boot try it for a while see how it does you come back, you’re still hurting so then they say well I don’t know why don’t we get an MRI.
They get an MRI but the MRI doesn’t give you that many pictures or that like really highly detailed information about the navicular, some other studies do. You should get a CT scan not an MRI or an x-ray. The CT scan classification system for classifying these injuries was developed by Amol Saxena and they use CTs not MRIs, not x-rays. X-rays, it will take a long time before something shows up or it has to be really severe for it to show up on an x-ray so that is number one relying on the x-rays or MRIs to determine the severity of the injury.
Second mistake not using crutches this is a really serious injury I would not take somebody who has a navicular stress fracture and let them walk on it. I just personally wouldn’t at least maybe I would, but I haven’t had that circumstance yet, so I think that you have to think about this your goal is to return to running not just get the navicular fracture to heal.
If you can walk on the navicular fracture but it will heal in 6.8 months let’s say and it will be healed in 6.8 months with you walking around in a fracture walking boot, what do you think is going to happen to your running fitness, your ability to run your running form all of those things over the course of six to eight months of waiting for it to heal.
If you can use crutches it is going to heal faster, I think you can take that to the bank and so if you decrease the stress and strain by using crutches or a knee walker, scooter something like that during this initial time I think you will be in a fracture walking boot a whole lot shorter time and that will actually speed up the process.
The third mistake that I see is I see runners who have a navicular fracture the fractures in the foot, so they put them in a short fracture walking boot. I don’t ever use short fracture walking boots. I think if you need a short fracture walking boot, you might as well wear hiking boots. They don’t really immobilize you that much and every time you move your ankle every time your foot wiggles around in the boot it does compress move the navicular implies stress to the fracture. You’re trying to get it to heal. The point of immobilizing it’s to hold it still enough that is going to heal as fast as possible. I would not use a short fracture walking boot.
The fourth mistake I see is sleeping without the fracture walking boot. I know you think well I’m just sleeping, I’m resting, I’m letting it heal. No, you’re not. When you are sleeping and you have a navicular fracture, every time you roll over, you move the foot and when you go this way it actually compresses the navicular and when you go that way it compresses the other side of the navicular and distracts the ligaments on this side of the navicular.
Moving around when you’re sleeping is going to move the fracture. You need to immobilize it. You need to keep it still and if you’re sleeping without the fracture walking boot just like if you’re walking on it, it will take you significantly longer to heal. Is it fun sleeping in a fracture walking boot? No, I did it for six weeks when I was in med school and had a stress fracture and I did not like sleeping in the boot. However, I believe firmly that it will make you heal faster.
The fifth mistake that runners make is that they don’t get a bone stimulator. A bone stimulator is a thing that changes the way that the bone heals and speeds up the process. I’m not going to go through all the science on it on this episode, but it will make bones heal faster when they are broken. And so if you have an injury that we know has a high probability of putting you in the operating room or not healing or taking a really long time to heal and prevent you from getting back to running in a reasonable amount of time, doing anything that you can to speed up the healing process like using a bone stimulator can help.
Most doctors never mention it to you because they have to write a letter to get it approved but bone stimulators I believe can really help and almost all the time when somebody has a navicular stress fracture I get them a bone stimulator.
Hopefully this helps you understand a little bit more about the top five navicular stress fracture mistakes and runners so that you don’t make them. If you want to learn more about the general strategies the exact step-by-step process I use with runners with stress fractures in the foot, you can get it for free at the stress fracture masterclass. It’s a deep dive into all the exact strategies I teach to physicians when I go lecture at medical conferences on stress fractures. Just go to www.docontherun.com/stressfracturemasterclass and I’ll see you in the training.
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