The tarsal navicular is the keystone of the medial longitudinal arch, articulating with the talar head proximally and the three cuneiforms distally. The tibialis posterior tendon inserts on its tuberosity (medial navicular prominence). Navicular stress fractures — one of the most serious foot stress injuries — occur in the avascular middle third of the navicular in running athletes.
Navicular stress fractures present with dorsomedial midfoot pain in sprinters and basketball players with insidious onset. The middle third is avascular and stress fractures here heal poorly without absolute non-weight-bearing for 6-8 weeks. CT confirms incomplete versus complete fractures. Complete or displaced navicular fractures require surgical fixation. An accessory navicular (Type II) from a bifurcated ossification can produce medial midfoot pain from synchondrosis disruption in athletes.
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