Purpose of the study: The purpose of the study was to propose an algorhythm for nonoperative treatment of partial tarsal navicular stress fractures in athletes, based on the results of the authors prospective research, conducted in 17 athletes.
Materials and methods: The series included 17 patients with 18 partial tarsal navicular stress fractures (9 women and 8 men), average age 20.1 years. Patients were 10 track and field athletes mainly sprinters, 3 basketball players, two handball players, one soccer player and one volleyball player. After undergoing detailed physical examination which included x-ray examination, all patients also underwent bone scanning, and some kind of tomographic imaging (CT, MR) was done in all patients. Since all patients suffered from partial tarsal navicular stress fracture (fracture spreaded saggitally to maximal dorsal half of the bone) nonoperative treatment was conducted. Immobilization in a non weight bearing short-leg cast for a period of 6-8 weeks was followed by rehabilitation treatment consisting of 4 consecutive stages, each lasting 2 weeks. Control examination after each stage determined if patients could proceed to the following stage or if they should remain in the same stage for another two weeks.
Results: Patients were followed up from one to five years (average 33.9 months) and proposed algorhythm of nonoperative treatment resulted in all, except two athletes, returning to their previous level of competition activity. The average time period between initiation of treatment and resumption of full sports activity was 24 weeks (range 17 to 32 weeks). One stress fracture recurrence was encountered although all patients returned to sports activities and are constantly being monitored.
Discussion: No complex tarsal navicular stress fractures was found in our series. In our opinion the diminishing number of complete fractures is a consequence if quicker and more precise diagnosis. The period between the onset of symptoms and the time of correct diagnosis is becoming shorter. In our patients, this period was 3.3 months. The nonoperative treatment for tarsal navicular stress fractures was suggested with a wide variety of procedures. Based on the results if their prospective study the authors propose an algorhythm of conservative procedures in the treatment of partial tarsal navicular stress fracture.
Conclusion: If clinical indication of tarsal navicular stress fracture is confirmed by a positive bone-scan, a CT or MRI exploration is required to distinguish stress reaction from stress fracture. In partial tarsal navicular stress fractures, immobilisation in a short-leg cast with nonweightbearing for 6 to 8 weeks depending of the magnitude of the fracture is required. This is followed by a treatment consisting of 4 two-weeks stages which clinically monitored. The previous phase can be repeated for another two weeks, depending of clinical findings. This algorhythm of nonoperative treatment of partial tarsal navicular stress fractures allowed in all athletes a return to competitive activity.