What are the four times a navicular fracture might need surgery? Well, that is what we’re talking about today on the Doc On The Run Podcast.
I have recently had for some reason a rash of patients that have navicular fractures and navicular fractures are bad. The navicular is a bone that is right on the top of your foot in front of your ankle and it’s also at the apex of your arch.
So, you could have pain on the top of the foot, you could have pain on the side of the foot, but either way if a doctor is trying to talk you into surgery as a runner that is probably going to make you understandably nervous. There are four times when you might really need to have surgery for a navicular fracture. We are going to talk about those.
The first one is when you have what’s called a comminuted fracture. That means it is a cracked and split and shattered into a whole bunch of pieces. So, comminuted is just a medical term for shattered. So, usually the comminuted fracture happens because of trauma like you fell off of a ladder or your kind of really bad accident where it actually applied so much force to the foot that it actually shattered the bone into multiple pieces.
If it’s in multiple pieces, it’s going to have to be fixed and much of the time because there’s so much cartilage on either side of the navicular, your doctor might recommend they go in and just fuse the bones on either side of it so that it’ll heal and not have arthritis later. That is a whole different story on why that might be a bad thing and why that might make you queasier if you’re a runner.
The second time is when you have what’s called a displaced navicular fracture. So, if you crack the bone and it breaks apart into two pieces and one of them is tilted or out of position, well that is not good. It’s not going to heal correctly and there’s no way the joint surfaces can align and move without pain if they’re not together in the right place. So, when it’s displaced the surgeon will generally do a thing called open reduction and internal fixation or ORIF.
All that means is we open your foot, we open that space, we put the navicular back together, put screws in it. I invented a surgical instrument called the tarsal joint distractor that some doctors use in that surgery which allows you to put a distractor on these bones here and the top of your talus and open it up and spread it so that you can manipulate the navicular without all that pressure on it from the surrounding bones but you have to get it back together. If it’s not back together correctly it’s unlikely to heal and allow you to run without pain later.
The third time is when you have a non-displaced fracture meaning it’s in the right place, it’s cracked but it hasn’t yet moved out of position or that gap in the fracture hasn’t opened up yet. Well if it’s in the right place we want to keep it in the right place and so sometimes one of the things I recommend at conferences, my lecture to physicians about this is I say you know if you have a runner with a stress fracture and has a crack but it hasn’t displaced yet, it’s early on in their treatment, it is a good idea to go in and put a screw across that fracture to hold it stable so that it will heal faster and so that the runner more importantly can move, retain some flexibility, retain some strength and some fitness and be more prepared to run once it’s actually healed.
If you have a non-displaced stress fracture that is visible with a crack on it, it is reasonable for your doctor to go in there and put a screw in it so that you can just workout sooner and maintain your running fitness better.
The fourth time your doctor might recommend surgery if you’ve had a navicular fracture is when you develop what’s called a non-union. A non-union means it does not unite, the pieces of bone don’t join back together and so if you get a crack in the navicular, you walk around on it, use a fracture walking boot, it continues to ache and you don’t tell your doctor and it hurts for a long period of time and then it actually doesn’t heal, it’s usually because you got scar tissue between those pieces.
In that case, that same instrument I invented, we put on the top of the navicular, we would open up that space, we would clean out all the scar tissue, put it back together, maybe put in a bone graft if necessary but then put some screws or some staples or something to hold it in place and let that bone actually heal.
But if you get a navicular fracture, those are basically the four times. One, when you shatter it, and it really is destroyed and it’s not going to likely heal without surgery. Number two, when it’s moved apart and it’s not going to get back together without surgery. Number three, when you have a stress fracture that is in the right position but we really want to make sure that you can maintain your fitness and get back to running sooner by working out while it’s healing and when you’ve messed it up or you haven’t paid attention to it and it just didn’t heal and it’s not going to heal without surgery.
Hopefully, this helps you understand a little bit more about the four times that doctors might recommend surgery if you’re a runner and you have a navicular fracture.
If you’ve got a navicular fracture, you want to learn more about the strategies I teach to physicians, the strategies that I teach for stress fractures actually apply here and the stress fracture master class walks you through the exact step-by-step approach I take with elite runners who have fractures as well as the strategies I teach to physicians when I go to these medical conferences to lecture on fracture patterns in runners. You can get that for free www.docontherun.com/stressfracturemasterclass. So, come check it out and I’ll see you in the training.
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