Have you experienced pain around the inner part of your foot? Is there a bony tender point to touch? There is a high possibility that it could be a navicular injury.
What is the Navicular?
The navicular is a short bone that has a palpable tuberosity (it sticks out a bit) just above the arch of the midfoot. The role of this bone is to maintain the arch of your foot, allowing the intrinsic plantar muscles to work.
What injuries can occur at the Navicular?
There are a multitude of injuries that can occur at the middle of your foot at the Navicular bone, but today we are just focusing on 5 of the most common conditions:
- Tibialis posterior insertional tendinopathy – pain and inflammation around the inside of your footÂ
The role of the muscle is to support the larger calf muscles in planting the foot at the ankle (talocrural) joint to propel the body forwards and in vertical movement like hopping. The second role of this muscle and tendon is to invert (point inwards) at the subtalar joint. If these movements are overloaded possibly by running too far too quickly or a change to fell running where ground is uneven, you may risk developing a tendinopathy (overload irritation of the tendon).
- Stress fracture – tiny cracks in a bone
Similarly to the first condition – if a bone is overloaded, in rare cases, you may incur a stress fracture at this site. Whilst stress fractures are rare it is important to be aware that up to 35% of foot stress fractures occur at the Navicular. An x-ray would be required to rule out or confirm this diagnosis. Typically, this would be advised if the pain was constant, unremitting pain that was not improving with rest or rehab.
- Avulsion fracture – when a bone fragment is separated from the rest of the boneÂ
Typically occurring following trauma to the foot directly, like getting hit by a hockey ball, a football tackle, or a rare eversion ankle sprain. Accounting for only about 5% of all ankle sprains there is always a risk of avulsion due to the high level of force required to cause the injury. The inner ankle (deltoid ligament) that protects the medial ankle is extremely robust. If you have tenderness around the navicular after medial ankle sprain, especially if there is swelling and bruising, it is recommended that you have an x-ray to confirm or rule out a fracture.
- Paediatrics conditionsÂ
Should you have a child with pain in the Navicular area it is important that you discuss with a health care professional that has skills to work with children and their musculoskeletal complaints. Conditions like Kohler’s disease (Necrosis/bone death due to poor blood supply) and Coalition (joining together of one or multiple bones) can be rare and difficult to diagnose.
- Accessory Navicular – an extra bit of bone on the inner arch of the footÂ
Around 2.5% of us are born with a little bit of extra bone that may poke out more than the average foot. Should this worry you? No. Can this cause pain? It shouldn’t. In rare case studies we have seen speciality footwear or orthotics being involved to offload pressure of the extra bone and cartilage. It is likely that pain is caused by overload injury rather than your normal skeletal makeup.
Why is the Navicular bone important?
- First off, get a thorough examination that covers range of motion, palpation, strength, balance and reactive forces of the foot and ankle.
- De-load from aggravating movements for a short while to give yourself a chance to recover.
- Slowly load back up starting with open chain movements like band resisted pointing of the toes and inverting (turning the foot inwards).
- Progress to bodyweight strengthening, then onto hopping and finally faster plyometric rehabilitation. If you struggle to progress or if the pain is just too constant, highly irritable or possibly severe, it may be time for an x-ray to rule out problems such as a stress fracture. We can facilitate both conservative management and imaging where necessary.
We will always recommend visiting a specialist sports physio for a confirmed diagnosis and to improve your recovery time. Get in touch with our physios to develop your own tailored program so you can get back on track – get in touch with us.
Author: Dominic Moon, Pure Physio Sports Lead (North) and Specialist MSK Physiotherapist