Question 1

I'm a runner and my doctor said I have a navicular stress fracture—he wants me non-weight-bearing in a boot for 8 weeks which seems excessive for a 'stress fracture.' Can't I just rest from running for a few weeks instead?

Accepted Answer

The 8 weeks strict non-weight-bearing recommendation is evidence-based and critical for navicular stress fractures—this is NOT an ordinary stress fracture you can just 'rest' through. Here's why such aggressive treatment is necessary: NAVICULAR ANATOMY: The navicular bone has notoriously poor blood supply, especially the central third (where most stress fractures occur). Blood vessels enter from edges of bone, leaving central zone relatively avascular (poor blood flow). When fracture occurs in this zone, healing is extremely difficult without complete protection. NATURAL HISTORY WITHOUT TREATMENT: Early studies of athletes with navicular stress fractures treated with 'relative rest' (reduced running, continued weight-bearing) showed: 60-80% developed nonunion (fracture never healed), many requiring surgery later. Those who eventually healed took 6-12+ months and many couldn't return to sport. This is why orthopedic surgeons now recommend aggressive treatment upfront. CURRENT EVIDENCE: Strict non-weight-bearing immobilization for 6-8 weeks gives: 70-80% union rate (fracture heals), return to sport at 12-16 weeks in most cases. Surgery (screw fixation) gives: 85-90% union rate, return to sport at 12-16 weeks. The trade-off is clear: 6-8 weeks of inconvenience (non-weight-bearing) for 70-80% chance of healing vs prolonged attempted conservative treatment with 60-80% failure requiring surgery anyway. CONSEQUENCES OF HALF-MEASURES: If you continue walking normally or try to 'run through it,' fracture will NOT heal and will likely progress to complete fracture or established nonunion. You'll then need surgery (screw fixation) and potentially longer recovery than if you'd done non-weight-bearing initially. Some athletes lose entire season (or career) by not taking stress fracture seriously early. REALISTIC PLAN: Accept 6-8 weeks non-weight-bearing (you can still upper body train, swim with pull buoy, cycle one-legged on stationary bike). Get repeat CT at 6-8 weeks. If healing well, progressive return to running over 4-6 weeks with PT. Most runners back at pre-injury mileage by 16 weeks. Alternative: if you can't afford 6-8 weeks non-weight-bearing (elite athlete with competition, professional athlete), discuss surgical screw fixation with your surgeon—may allow earlier return with higher success rate.

Question 2

I broke my navicular bone in a car accident 4 months ago, was treated with a boot and non-weight-bearing for 8 weeks, but I'm still having significant pain and my surgeon says it hasn't healed (nonunion)—how does this happen and what now?

Accepted Answer

Navicular nonunion (failure to heal) is unfortunately common (10-30% depending on fracture type) despite appropriate treatment because of the bone's poor blood supply and critical biomechanical forces. Here's what happened and your options: WHY NONUNION OCCURS: Even with proper treatment, navicular has inherent challenges: (1) Poor blood supply—central third of navicular is relatively avascular. Fracture site doesn't get enough blood flow to heal normally; (2) Biomechanical stress—navicular is keystone of foot arch, subjected to high compressive and shear forces with every step. Even when non-weight-bearing, muscle forces through foot still stress fracture; (3) Fracture displacement—your acute fracture from car accident likely had some displacement (even if minimal), creating gap fracture fragments must bridge; (4) Smoking, diabetes, NSAIDs, or other factors impair healing. CONFIRMING NONUNION: Your surgeon likely ordered CT scan at 3-4 months showing: persistent fracture line with no bridging bone, possible sclerosis (hardening) of fracture edges indicating established nonunion rather than just delayed union. You have ongoing pain because fractured fragments are moving with each step, preventing healing. TREATMENT OPTIONS: (1) Surgical fixation with bone graft—gold standard for navicular nonunion. Surgeon opens fracture, removes scar tissue, adds bone graft (from your pelvis or synthetic) to stimulate healing, fixes with screws to compress fracture. 80-90% heal with this approach. Post-op: 8-12 weeks non-weight-bearing, then gradual return to activities; (2) Bone stimulator—external device worn over navicular that delivers ultrasound or electromagnetic pulses to stimulate bone healing. Some evidence for improving union rates in delayed unions (fractures healing slowly but showing some progress). Less effective for established nonunion (complete failure of healing); (3) Revision non-weight-bearing—occasionally for very early nonunion (3-4 months post-injury) surgeon may recommend repeat CT in 2 months with continued non-weight-bearing. Rarely successful if no healing signs by 4 months. RECOMMENDATION: For established nonunion at 4 months with ongoing pain, surgical treatment (ORIF with bone graft) is most reliable option. Continued conservative management rarely successful at this point and prolongs your disability. Surgery has 80-90% success rate and gets you back to activities. TIMING: Don't delay surgery unnecessarily—the longer nonunion persists, the more bone around fracture hardens (sclerosis) and harder it is to get it to heal. Optimal timing for nonunion surgery is 3-6 months after failed conservative treatment.

Medical Disclaimer

Broken Midfoot Bone (Navicular Fracture)

📖What is Broken Midfoot Bone (Navicular Fracture)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention