Walking on a navicular fracture12/4/2023 ![]() ![]() 1 However, from a differential diagnosis assessment perspective, it is necessary to consider conditions of significance occurring at the margins of the more strictly applied anatomical boundaries. Bony anatomy of the foot – relationship of mid-foot bones to metatarsals and proximal tarsal bonesĪnatomically, the mid-foot is the region distal to the talus and calcaneus, and proximal to metatarsal bases ( Figure 1). Recent trends in imaging and medical management will be outlined. 1 The aim of this article is to provide some guidance in recognising and managing red flag conditions in this region. Delay in diagnosis has a potentially adverse impact on outcome. However, there is a clustering of diagnoses occurring in the mid-foot region, including navicular bone stress, Lisfranc ligament disruption and tibialis posterior dysfunction, that require sound management. Unfamiliarity arising from infrequent presentations adds to management difficulties in the primary care setting. The blood tests recommended are calcium, phosphate, parathyroid hormone, 25 hydroxy vitamin D, an MBA 20 and a spot urinary DPD/creatinine.Overall in general practice presentations, acute and overuse mid-foot conditions may not be encountered frequently. If there is a question of low bone density then the patient will need a bone density assessment with blood tests and a scan. I also suggest to the patients that they mix up their training regime to include cycling and swimming i.e. Return to activity: once the stress fracture has healed any biomechanical anomalies in the foot should be corrected with a change of shoes and orthotics. If I am in doubt about the diagnosis then an MRI scan is indicated.This x-ray will often show callus and confirm the diagnosis. I will generally follow the patient up with a further x-ray a month to 6 weeks later.The boot ought to be taken off to shower, to go to bed and to move the patients foot up-and-down a hundred times a day to prevent a DVT. However, if the patient is not in excruciating pain then rest in a short walking boot for 3-4 weeks.If the patient is in excruciating pain then crutches nonweight bearing for two weeks.Resting the affected foot is the mainstay of treatment.Most often however the diagnosis is clinical.In the past bone scan was the preferred investigation but these days MRI has superseded bone scan.Plain x-rays are always taken but are often normal.They are usually exquisitely tender to palpation over the affected metatarsal.The patient has swelling on the dorsum of the foot.Often in the history the patient will report trying to get fit, going to the gym and performing high-impact activity though this is not invariably the case.Ī dietary history of the patient is important as certain diets low in calcium can predispose patients to stress fracture. They also occur in the presence of low bone density such that normal walking can produce a stress fracture.They were described in military recruits with normal bone who were marching and overloaded their metatarsals.Stress fractures generally occur in two situations: The pain can be excruciating and prevent the patient from walking.The patient will complain of pain and swelling on the top of their foot.The comments below relate to metatarsal stress fractures: Stress fractures however can also occur in cuneiforms, navicular, talus, distal tibia and distal fibula. The most common fractured bone is a metatarsal (usually the second or third). Stress fractures of the foot and ankle are extremely common. ![]()
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