Here’s my story:
Finished IMC 2010 after a 8 year work related hiatus and started training for the next season. Suspected a navicular stress fracture which was confirmed with bone scan and CT in January 2011
CT Report:
CORTICATED BONE FRAGMENT AT THE DORSAL ASPECT OF THE TALONAVICULAR JOINT LIKELY DUE TO OLD AVULSION FRAGMENT. SMALL AREA OF ADJACENT FOCAL SCLEROSIS WITH A TINY LINEAR LUCENCY AT THE PROXIMAL, DORSAL MARGIN OF THE NAVICULAR BONE. THE APPEARANCE IS CONSISTENT WITH A STRESS FRACTURE OF THE DORSAL ASPECT OF NAVICULAR BONE. THE REST OF THE TARSAL BONES AND INTERTARSAL JOINTS ARE OTHERWISE INTACT.
What the CT report didn’t state was that there is an ossicle (supranaviculare) which sits like a wedge directly in the area of the break.
Spent 6 weeks in a non weightbearing cast and ultrasound bone growth stimulator into March 2011 and started weightbearing again. However the pain persisted and an MRI on June 21st confirmed the bone is still broken but healing.
MRI Report: THE MR FINDINGS ARE COMPATIBLE WITH A HEALING NONDISPLACED FRACTURE OF THE DORSAL NAVICULAR CORRESPONDING TO THE STRESS FRACTURE DOCUMENTED ON PRIOR STUDIES. THERE IS NO EVIDENCE OF COMPLICATING AVN. NO ADDITIONAL FRACTURES ARE IDENTIFIED.
The physician now prescribes continuing weightbearing and slow start with exercise, after all the bone is healing.
The pain however never goes away and a follow up MRI in October shows the exact same image seen in June.
Spent another 6 weeks in a non weighbearing cast and ultrasound bone growth stimulator and am still in pain now when walking more than 500yrd per day. My physician now suspects nonunion and I am referred to an orthopedic surgeon but it will take well into August 2012 for me to even see one (hooray for Alberta Health).
I have all images here (will send as DICOM or JPG) and am looking for someone out there who could have a look to tell me if surgery would help or what else to do.
Thanks
13 months? Wow. Sounds like you have covered all the usual conservative treatment though, including your exogen bone stim.
Yes, I would certainly recommend ORIF at this point (and often do for type II Navicular stress fx in athletes since they seem to be damn slow healers in my experience, despite what the literature might say). You seriously can’t see a specialist (and BTW, a general orthopedist may or may not have done/seen many of these) for another 6 months?
I am not a doctor or orthopedic surgeon.
I have gotten a stress fracture in my navicular, so I will offer the only things that I know from that experience.
- the navicular is the thickest bone in your foot
- it takes a LONG time to heal
- mine took a solid year to heal of no running at all (ruined my hs xc career actually)
You seriously can’t see a specialist (and BTW, a general orthopedist may or may not have done/seen many of these) for another 6 months?
Nope, I was referred in December and was told in January it will take 6-8 months at least and I have no influence on who I will be seeing. I walked into a specialists clinic, her waiting list is >2 years. Alberta is lacking a ton…it took 8 weeks of waiting for each MRI
You seriously can’t see a specialist (and BTW, a general orthopedist may or may not have done/seen many of these) for another 6 months?
Nope, I was referred in December and was told in January it will take 6-8 months at least and I have no influence on who I will be seeing. I walked into a specialists clinic, her waiting list is >2 years. Alberta is lacking a ton…it took 8 weeks of waiting for each MRI
Wow - OK. Well, the good news is that you actually might be healed by then (19 months later) and that you should be a great swimmer by then 
Would lose an entire season? Can you get over to Vancouver? Any better there? Would be a fairly expensive surgery in the states between facility/anesthesia/surgery fees, but could likely be done within a couple of weeks.