Common Hurdler Injuries: Navicular Stress Fracture
by Melinda Burris

This article is part of our ongoing series examining injuries frequently seen in hurdlers and an explanation of why there is such a propensity for hurdlers and track athletes to contract these injuries, the symptoms and methods of diagnosis and treatment, as well as standard recuperation times. Also examined are ways to avoid these injuries as prevention truly is worth a pound of cure.

The foot is a complex lower limb, consisting of several small bones that all work together to provide the body with balance and support, making movement possible. The tarsal navicular bone is one of seven tarsal bones found in the midfoot. It is positioned along the inner edge of the foot and links the ankle bone to the other tarsal bones, giving support to the arch of the foot.¹

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Experts explain that the location of the tarsal navicular bone leaves it susceptible to injury when athletes are performing exercises that require jumping or running. The bone is also prone to fracture when it is overused.¹ Often described as flat, concave, and boat-shaped, this bone takes its name from the Latin word navicula, meaning little ship.

Because of its shape and location, some areas of this important bone often suffer from decreased blood flow, a primary factor for why it is so easily prone to injury and can be resistant to healing. Care must be taken when a stress fracture develops in this bone, for if it isn’t, additional stress or attempting to put full pressure on the bone before it is completely recovered can lead to a full-blown break of the bone.¹

Those Most at Risk for This Type of Injury

As mentioned previously, this is a common injury. In fact, research shows that between 14% to as much as one-quarter of all stress fractures occur to the tarsal navicular bone. Hurdlers take note! A report authored by two medical doctors in 2024 revealed, “In contrast to most stress fractures, [those involving the navicular bone] are predominantly in male athletes (e.g. hurdling, jumping).”¹ They further noted, “The middle third of the navicular bone is the most frequently affected area. It is relatively avascular, with a negative impact on healing.”¹ To reiterate, the lack of natural blood flow to this area of the foot makes healing more difficult and slower.

So, why is it so easy to injure this particular bone? As noted, the tarsal navicular bone is necessary to provide the inner (medial) longitudinal arch the stability it requires when the foot is exposed to the high compression forces of sprinting and hurdling. Individuals with high arches, decreased ankle dorsiflexion (a lowered ability to lift your foot up and back toward the shin), and an index-minus morphotype (a classification of metatarsal or toe length) are factors that can intensify compression loading in the navicular, resulting in a higher risk of stress fracture.²

Other Factors That Can Increase the Risk of Navicular Stress Fracture

• Overtraining or training too intensely.¹
• Wearing new shoes or using a different training surface.¹
• Not getting proper nutrition.¹
• Low bone density.¹
• Having high arches.¹

Symptoms

A navicular stress fracture, like most injuries, presents a variety of symptoms. These can range from dull pain from the top of the ankle spreading across the left or inner side of the foot and arch to soreness when the navicular bone is touched. The pain intensifies when the affected person is asked to do physical movements such as hopping on one leg or walking on their tip toes. With this condition, the level of pain generally increases gradually over time, progressing from acute to chronic.² The pain may initially subside when the person refrains from high-intensity exercise but left untreated, the pain will surface when simple movements such as walking are undertaken until the stress fracture causes pain even when at rest.¹

Diagnosis

Because of where the tarsal navicular bone is located, simple X-rays are often ineffective in identifying navicular stress fractures. The more detailed imagery MRIs provide makes this test the preferred method for accurately diagnosing this type of injury.²

Treatment Methods

If diagnosed early, a navicular stress injury is treated by immobilizing the foot and keeping weight off of it for one to three weeks or until the navicular bone (also known as the N-spot) is no longer sore to the touch. Recuperation time is lengthy, however, typically anywhere from four to six months as the athlete gradually is allowed to place more load bearing on the affected foot.² Patience is required as a return to load bearing on the affected foot must be a slow, incremental process to ensure no further damage is done. The standard recommendation is to “increase training by no more than 10-15 percent each week to allow for adequate recovery.”¹

When the injury has not been diagnosed and treated early, the damage can progress to the point where surgery is the preferred and best option for optimal recovery. ²

Measures You Can Take to Prevent This Injury

Orthopedic surgeon Dr. Michael Johnson emphasizes three things you can do to mitigate your chances of suffering a navicular stress injury or worse, a break:

1. Quality shoes with a rigid sole and proper cushioned support at the arch are a must when training or participating in any competitive endeavor. Johnson also recommends that you “replace your shoes after 300-500 miles of use.” ³
2. If you are beginning a new training program, take it slow, adding elements in stages and being careful not to increase your running or walking distance by more than 10% each week.³
3. Remember to do proper warmups! Pay particular attention to stretching your calf muscles and the Achilles tendon, before you begin your workout.³

References:

1. Smith, Dr. Marissa M., & MacCallum, Dr. Diasy-Scarlett. (2024). Navicular Stress Fracture.
2. Thomas P.A. Baites, et al. (26 September 2019). Clinical Approach to Common Foot & Ankle Stress Fractures in Athletics.
3. Johnson, Dr. Michael. (2024). Navicular Stress Fracture.

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