Navicular Fracture

Navicular Fracture

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The navicular plays an important role in maintaining the medial longitudinal arch of the foot. Commonly, fractures of the navicular are not evident on plain radiographs. This often leads to a delay in diagnosis, which may result in prolonged disabling foot pain in individuals, particularly young athletes. The 4 types of navicular fractures are (1) cortical avulsion, (2) tuberosity, (3) body, and (4) stress. [1, 2, 3, 4, 5]

Avulsion fracture, the most common fracture of the navicular, is often associated with ligamentous injuries and results from twisting forces on the mid foot. These fractures are commonly treated conservatively, except for avulsion of the posterior tibial tendon insertion (tuberosity fracture), which may be repaired operatively, especially if a proximal dislocation of 1 cm or more is present. An avulsion of the posterior tibial tendon insertion must be differentiated from an accessory navicular (see Other Problems to Be Considered).

Fractures of the body are commonly associated with other injuries of the midtarsal joint. Sangeorzan et al categorized navicular body fractures into 3 types, as follows [6] :

Type 1 is a coronal fracture with no dislocation.

Type 2 is a dorsolateral to plantomedial fracture with medial forefoot displacement.

Type 3 is a comminuted fracture with lateral forefoot displacement and carries the worst prognosis.

All navicular body fractures with 1 mm or more of displacement require open reduction and internal fixation.

The rest of this article primarily discusses the diagnosis and treatment of navicular stress fractures, which are usually sports-related injuries.

In 1855, Brehaulpt first described stress fractures in military recruits who were subjected to long marches. As more civilians took up physically demanding sports, the incidence of stress fractures has increased in the general population. Towne et al first described stress fracture of the tarsal navicular in 1970. [7]

In athletes, navicular stress fractures are of particular concern because they are underdiagnosed and can lead to significant disability if the diagnosis is delayed. [1, 2, 3, 4, 5, 8] In a study by Torg et al in 1982, the average time between the fracture and diagnosis was estimated to be 7 months. [9] Given the significant improvement in outcome with early diagnosis and proper treatment, navicular stress fractures should be considered in any athlete with midfoot pain. In a 2006 study by Saxena and Fullem, navicular stress fractures took up to 4 months to heal posttreatment. [10]

Fracture-dislocation of the navicular may occur in athletes. [11, 12, 13, 14, 15, 16, 17, 18] This uncommon injury generally requires reduction and examination for stability via fluoroscopy, with the patient under general anesthesia. If the postreduction examination findings confirm stability of the navicular, treatment with a non–weight-bearing cast may be sufficient; otherwise, internal fixation is required.

For excellent patient education resources, visit eMedicineHealth’s First Aid and Injuries Center. Also, see eMedicineHealth’s patient education articles Broken Foot and Cast Care.

United States

Navicular stress fractures may account for up to 35% of stress fractures in athletes. Because navicular stress fractures are not easily observed on plain radiographs, the reported incidence rates vary widely. The overall incidence may appear to be increasing due to advances in imaging. [19, 20, 21, 22, 23, 24, 25]

Among track-and-field athletes, up to 21% may experience a stress fracture in the course of a year. [26, 27] In these athletes, up to 15% of stress fractures are of the navicular. [26] Other studies have demonstrated similar findings. [28, 29, 30, 31] The highest incidence of stress fractures is in jumping and sprinting events.

Among military recruits, the incidence is approaching that of athletes, as the training of military recruits closely mirrors the training of athletes. [28, 32, 33, 34]

International

Worldwide, the incidence of navicular stress fracture is related to the sport of participation and to the training that is involved rather than to geographic location.

The tarsal navicular is a disk-shaped bone that articulates distally with the 3 cuneiforms, proximally with the talar head, and, occasionally, laterally with the cuboid. The distal articulation with the 3 cuneiforms is by means of 3 facets that have a common synovial cavity. The plantar and dorsal cuneonavicular ligaments reinforce the distal articulation.

On the lateral side are the plantar, dorsal, and interosseous cuboideonavicular ligaments and, occasionally, a syndesmotic joint with the cuboid. Medially, the distal articulation serves as an attachment for the posterior tibial tendon and the spring, or plantar calcaneonavicular, ligament. On the proximal side, it envelops the talar head completely. The thickened talonavicular ligaments reinforce the talonavicular joint in a plantar and dorsal orientation. Medially, the anterior fibers of the deltoid ligament add support.

Along with the calcaneocuboid joint, the talonavicular joint forms the transverse tarsal joint, which allows motion of the forefoot on the hindfoot. The ligamentous structure is such that when the hind part of the foot is everted, the joint is mobile, and when the hind part of the foot is inverted, the joint is fixed.

The blood supply of the navicular comes from small branches of the posterior tibial and dorsalis pedis arteries. This supply leaves the medial and lateral areas of the navicular relatively well supplied compared with the central section of the navicular. This relative difference correlates with the common site of stress fractures.

The navicular is part of 2 important structures that are essential for normal gait: (1) the medial longitudinal arch and (2) the transverse tarsal joint (also called the midtarsal or Chopart joint).

The medial longitudinal arch is composed of the navicular, calcaneus, talus, 3 cuneiforms, and 3 medial metatarsals. This arch provides support for normal gait, in particular from mid stance until push-off.

The transverse tarsal joint is essential for normal gait and is composed of the talonavicular joint and the calcaneocuboid joint. At heel strike, this joint is flexible and plays an important role in absorbing ground impact and accommodating the foot to the ground. At push-off, the transverse tarsal joint is locked and is helpful in forward propulsion.

Thordarson DB. Fractures of the midfoot and forefoot. Myerson MS, Leonard ME, eds. Foot and Ankle Disorders. 2nd ed. Orlando, Fla: Harcourt; 2000. 1265-85.

Dunjey M. Stress fractures in athletes. Department of Podiatry Encyclopedia. Perth, Australia: Curtln Health Science, Curtin University. 1999. 1-14.

Ho K, Abu-Laban RB. Ankle and foot. Rosen P, Barkin RM, eds. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St Louis, Mo: Mosby-Year Book; 1998. 836-56.

Marder RA, Lian GJ, eds. Midfoot: tarsal navicular stress fracture. Sports Injuries of the Ankle and Foot. New York, NY: Springer-Verlag; 1997. 64-8.

Heckman JD. Fractures and dislocations of the foot. Rockwood CA, Green DP, eds. Rockwood and Green’s Fractures in Adults. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1996. 2355-62.

Sangeorzan BJ, Benirschke SK, Mosca V, Mayo KA, Hansen ST Jr. Displaced intra-articular fractures of the tarsal navicular. J Bone Joint Surg Am. 1989 Dec. 71(10):1504-10. [Medline]. [Full Text].

Towne LC, Blazina ME, Cozen LN. Fatigue fracture of the tarsal navicular. J Bone Joint Surg Am. 1970 Mar. 52(2):376-8. [Medline]. [Full Text].

Simons SM. Foot injuries of the recreational athlete. Phys Sportsmed. 1999 Jan. 27(1):57-70. [Medline]. [Full Text].

Torg JS, Pavlov H, Cooley LH, Bryant MH, Arnoczky SP, Bergfeld J, et al. Stress fractures of the tarsal navicular. A retrospective review of twenty-one cases. J Bone Joint Surg Am. 1982 Jun. 64(5):700-12. [Medline]. [Full Text].

Saxena A, Fullem B. Navicular stress fractures: a prospective study on athletes. Foot Ankle Int. 2006 Nov. 27(11):917-21. [Medline].

Cohen M, Roman A, Lovins JE. Totally implanted direct current stimulator as treatment for a nonunion in the foot. J Foot Ankle Surg. 1993 Jul-Aug. 32(4):375-81. [Medline].

Samoladas E, Fotiades H, Christoforides J, Pournaras J. Talonavicular dislocation and nondisplaced fracture of the navicular. Arch Orthop Trauma Surg. 2005 Feb. 125(1):59-61. [Medline].

Pinney SJ, Sangeorzan BJ. Fractures of the tarsal bones. Orthop Clin North Am. 2001 Jan. 32(1):21-33. [Medline].

Garland DE, Moses B, Salyer W. Long-term follow-up of fracture nonunions treated with PEMFs. Contemp Orthop. 1991 Mar. 22(3):295-302. [Medline].

Fitch KD, Blackwell JB, Gilmour WN. Operation for non-union of stress fracture of the tarsal navicular. J Bone Joint Surg Br. 1989 Jan. 71(1):105-10. [Medline]. [Full Text].

Orava S, Hulkko A. Delayed unions and nonunions of stress fractures in athletes. Am J Sports Med. 1988 Jul-Aug. 16(4):378-82. [Medline].

Rymaszewski LA, Robb JE. Mechanism of fracture-dislocation of the navicular: brief report. J Bone Joint Surg Br. 1988 May. 70(3):492. [Medline]. [Full Text].

Coughlin L, Kwok D, Oliver J. Fracture dislocation of the tarsal navicular. A case report. Am J Sports Med. 1987 Nov-Dec. 15(6):614-5. [Medline].

Wall J, Feller JF. Imaging of stress fractures in runners. Clin Sports Med. 2006 Oct. 25(4):781-802. [Medline].

Lee S, Anderson RB. Stress fractures of the tarsal navicular. Foot Ankle Clin. 2004 Mar. 9(1):85-104. [Medline].

Craig JG, Jacobson JA, Moed BR. Ultrasound of fracture and bone healing. Radiol Clin North Am. 1999 Jul. 37(4):737-51, ix. [Medline].

Knapp TP, Garrett WE Jr. Stress fractures: general concepts. Clin Sports Med. 1997 Apr. 16(2):339-56. [Medline].

Arendt EA, Griffiths HJ. The use of MR imaging in the assessment and clinical management of stress reactions of bone in high-performance athletes. Clin Sports Med. 1997 Apr. 16(2):291-306. [Medline].

Alfred RH, Belhobek G, Bergfeld JA. Stress fractures of the tarsal navicular. A case report. Am J Sports Med. 1992 Nov-Dec. 20(6):766-8. [Medline].

Kiss ZS, Khan KM, Fuller PJ. Stress fractures of the tarsal navicular bone: CT findings in 55 cases. AJR Am J Roentgenol. 1993 Jan. 160(1):111-5. [Medline]. [Full Text].

Bennell KL, Malcolm SA, Thomas SA, Wark JD, Brukner PD. The incidence and distribution of stress fractures in competitive track and field athletes. A twelve-month prospective study. Am J Sports Med. 1996 Mar-Apr. 24(2):211-7. [Medline].

Bennell KL, Malcolm SA, Thomas SA, et al. Risk factors for stress fractures in track and field athletes. A twelve-month prospective study. Am J Sports Med. 1996 Nov-Dec. 24(6):810-8. [Medline].

Rome K, Handoll HH, Ashford R. Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Cochrane Database Syst Rev. 2005. 2:CD000450. [Medline].

Brukner P, Bradshaw C, Khan KM, White S, Crossley K. Stress fractures: a review of 180 cases. Clin J Sport Med. 1996 Apr. 6(2):85-9. [Medline].

Khan KM, Fuller PJ, Brukner PD, Kearney C, Burry HC. Outcome of conservative and surgical management of navicular stress fracture in athletes. Eighty-six cases proven with computerized tomography. Am J Sports Med. 1992 Nov-Dec. 20(6):657-66. [Medline].

Ting A, King W, Yocum L, et al. Stress fractures of the tarsal navicular in long-distance runners. Clin Sports Med. 1988 Jan. 7(1):89-101. [Medline].

Sanders TG, Williams PM, Vawter KW. Stress fracture of the tarsal navicular. Mil Med. 2004 Jul. 169(7):viii-xiii. [Medline].

Armstrong DW 3rd, Rue JP, Wilckens JH, Frassica FJ. Stress fracture injury in young military men and women. Bone. 2004 Sep. 35(3):806-16. [Medline].

Bennell KL, Brukner PD. Epidemiology and site specificity of stress fractures. Clin Sports Med. 1997 Apr. 16(2):179-96. [Medline].

Macintyre J, Joy E. Foot and ankle injuries in dance. Clin Sports Med. 2000 Apr. 19(2):351-68. [Medline].

Knapp T, Mandelbaum B, Garrett W Jr. Why are stress injuries so common in the soccer player?. Clin Sports Med. 1998 Oct. 17(4):835-53.

Zetaruk MN. The young gymnast. Clin Sports Med. 2000 Oct. 19(4):757-80. [Medline].

Bennell KL, Malcolm SA, Wark JD, Brukner PD. Skeletal effects of menstrual disturbances in athletes. Scand J Med Sci Sports. 1997 Oct. 7(5):261-73. [Medline].

Brockwell J, Yeung Y, Griffith JF. Stress fractures of the foot and ankle. Sports Med Arthrosc. 2009 Sep. 17(3):149-59. [Medline].

de Clercq PF, Bevernage BD, Leemrijse T. Stress fracture of the navicular bone. Acta Orthop Belg. 2008 Dec. 74(6):725-34. [Medline].

Saxena A, Fullem B, Hannaford D. Results of treatment of 22 navicular stress fractures and a new proposed radiographic classification system. J Foot Ankle Surg. 2000 Mar-Apr. 39(2):96-103. [Medline].

Diehl JJ, Best TM, Kaeding CC. Classification and return-to-play considerations for stress fractures. Clin Sports Med. 2006 Jan. 25(1):17-28, vii. [Medline].

Brukner P, Bradshaw C, Bennell K. Managing common stress fractures: let risk level guide treatment. Phys Sportsmed. 1998 Aug. 26(8):39-47. [Medline]. [Full Text].

Shakked RJ, Walters EE, O’Malley MJ. Tarsal navicular stress fractures. Curr Rev Musculoskelet Med. 2017 Jan 21. [Medline].

McCabe MP, Smyth MP, Richardson DR. Current concept review: vitamin D and stress fractures. Foot Ankle Int. 2012 Jun. 33 (6):526-33. [Medline].

Torg JS, Moyer J, Gaughan JP, Boden BP. Management of tarsal navicular stress fractures: conservative versus surgical treatment: a meta-analysis. Am J Sports Med. 2010 May. 38(5):1048-53. [Medline].

Potter NJ, Brukner PD, Makdissi M, et al. Navicular stress fractures: outcomes of surgical and conservative management. Br J Sports Med. 2006 Aug. 40(8):692-5; discussion 695. [Medline].

Coulibaly MO, Jones CB, Sietsema DL, Schildhauer TA. Results and complications of operative and non-operative navicular fracture treatment. Injury. 2015 Aug. 46 (8):1669-77. [Medline].

Raasch WG, Hergan DJ. Treatment of stress fractures: the fundamentals. Clin Sports Med. 2006 Jan. 25(1):29-36, vii. [Medline].

Trock DH. Electromagnetic fields and magnets. Investigational treatment for musculoskeletal disorders. Rheum Dis Clin North Am. 2000 Feb. 26(1):51-62, viii. [Medline].

Scott G, King JB. A prospective, double-blind trial of electrical capacitive coupling in the treatment of non-union of long bones. J Bone Joint Surg Am. 1994 Jun. 76(6):820-6. [Medline]. [Full Text].

Gossling HR, Bernstein RA, Abbott J. Treatment of ununited tibial fractures: a comparison of surgery and pulsed electromagnetic fields (PEMF). Orthopedics. 1992 Jun. 15(6):711-9. [Medline].

Guzel Y, Karalezli N, Bilge O, Kacira BK, Esen H, Karadag H, et al. The biomechanical and histological effects of platelet-rich plasma on fracture healing. Knee Surg Sports Traumatol Arthrosc. 2013 Oct 30. [Medline].

Wei LC, Lei GH, Sheng PY, Gao SG, Xu M, Jiang W, et al. Efficacy of platelet-rich plasma combined with allograft bone in the management of displaced intra-articular calcaneal fractures: a prospective cohort study. J Orthop Res. 2012 Oct. 30(10):1570-6. [Medline].

Vannini F, Di Matteo B, Filardo G, Kon E, Marcacci M, Giannini S. Platelet-rich plasma for foot and ankle pathologies: a systematic review. Foot Ankle Surg. 2014 Mar. 20(1):2-9. [Medline].

Malliaropoulos N, Alaseirlis D, Konstantinidis G, Papalada A, Tsifountoudis I, Petras K, et al. Therapeutic Ultrasound in Navicular Stress Injuries in Elite Track and Field Athletes. Clin J Sport Med. 2017 May. 27 (3):278-282. [Medline].

Mann JA, Pedowitz DI. Evaluation and treatment of navicular stress fractures, including nonunions, revision surgery, and persistent pain after treatment. Foot Ankle Clin. 2009 Jun. 14(2):187-204. [Medline].

Gillespie WJ, Grant I. Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Cochrane Database Syst Rev. 2000. 2:CD000450. [Medline].

Borges JL, Guille JT, Bowen JR. Köhler’s bone disease of the tarsal navicular. J Pediatr Orthop. 1995 Sep-Oct. 15(5):596-8. [Medline].

Ippolito E, Ricciardi Pollini PT, Falez F. Kohler’s disease of the tarsal navicular: long-term follow-up of 12 cases. J Pediatr Orthop. 1984 Aug. 4(4):416-7. [Medline].

Williams GA, Cowell HR. Köhler’s disease of the tarsal navicular. Clin Orthop Relat Res. 1981 Jul-Aug. 158:53-8. [Medline].

Staheli LT. Planovalgus foot deformity. Current status. J Am Podiatr Med Assoc. 1999 Feb. 89(2):94-9. [Medline].

Bayramoglu A, Demiryürek D, Firat A, Oznur A, Ozsoy MH. Differential diagnosis in a professional basketball player with foot pain: is it an avulsion fracture or an os supranaviculare?. Eklem Hastalik Cerrahisi. 2009. 20(1):59-61. [Medline].

Brukner P, Bennell K. Overuse injuries: where to now?. Br J Sports Med. 1997 Mar. 31(1):2. [Medline].

Bruns W, Maffulli N. Lower limb injuries in children in sports. Clin Sports Med. 2000 Oct. 19(4):637-62. [Medline].

DiGiovanni CW, Patel A, Calfee R, Nickisch F. Osteonecrosis in the foot. J Am Acad Orthop Surg. 2007 Apr. 15(4):208-17. [Medline].

Fowler JR, Gaughan JP, Boden BP, Pavlov H, Torg JS. The non-surgical and surgical treatment of tarsal navicular stress fractures. Sports Med. 2011 Aug 1. 41(8):613-9. [Medline].

Haverstock BD. Foot and ankle imaging in the athlete. Clin Podiatr Med Surg. 2008 Apr. 25(2):249-62, vi-vii. [Medline].

Hochman MG, Min KK, Zilberfarb JL. MR imaging of the symptomatic ankle and foot. Orthop Clin North Am. 1997 Oct. 28(4):659-83. [Medline].

Hoffinger SA. Evaluation and management of pediatric foot deformities. Pediatr Clin North Am. 1996 Oct. 43(5):1091-111. [Medline].

Hunter LY. Stress fracture of the tarsal navicular. More frequent than we realize?. Am J Sports Med. 1981 Jul-Aug. 9(4):217-9. [Medline].

Isikan UE. The values of talonavicular angles in patients with pes planus. J Foot Ankle Surg. 1993 Sep-Oct. 32(5):514-6. [Medline].

Khan KM, Brukner PD, Kearney C, et al. Tarsal navicular stress fracture in athletes. Sports Med. 1994 Jan. 17(1):65-76. [Medline].

Lyon RM, Street CC. Pediatric sports injuries: when to refer or x-ray. Pediatr Clin North Am. 1998 Feb. 45(1):221-44. [Medline].

Maitra RS, Johnson DL. Stress fractures. Clinical history and physical examination. Clin Sports Med. 1997 Apr. 16(2):259-74. [Medline].

Mann JA, Pedowitz DI. Evaluation and treatment of navicular stress fractures, including nonunions, revision surgery, and persistent pain after treatment. Foot Ankle Clin. 2009 Jun. 14(2):187-204. [Medline].

Manusov EG, Lillegard WA, Raspa RF, Epperly TD. Evaluation of pediatric foot problems: part I. The forefoot and the midfoot. Am Fam Physician. 1996 Aug. 54(2):592-606. [Medline].

Nielsen RG, Rathleff MS, Simonsen OH, Langberg H. Determination of normal values for navicular drop during walking: a new model correcting for foot length and gender. J Foot Ankle Res. 2009 May 7. 2:12. [Medline]. [Full Text].

Omey ML, Micheli LJ. Foot and ankle problems in the young athlete. Med Sci Sports Exerc. 1999 Jul. 31(7 suppl):S470-86. [Medline].

Orava S, Karpakka J, Hulkko A, Takala T. Stress avulsion fracture of the tarsal navicular. An uncommon sports-related overuse injury. Am J Sports Med. 1991 Jul-Aug. 19(4):392-5. [Medline].

Shindle MK, Endo Y, Warren RF, Lane JM, Helfet DL, Schwartz EN, et al. Stress fractures about the tibia, foot, and ankle. J Am Acad Orthop Surg. 2012 Mar. 20(3):167-76. [Medline].

Sims EL, Hardaker WM, Queen RM. Gender differences in plantar loading during three soccer-specific tasks. Br J Sports Med. 2008 Apr. 42(4):272-7. [Medline].

Thordarson DB. Detecting and treating common fractures of the foot and ankle part 2: the midfoot and forefoot. Phys Sportsmed. 1996 Oct. 24(10):58-64. [Medline]. [Full Text].

Wedmore IS, Charette J. Emergency department evaluation and treatment of ankle and foot injuries. Emerg Med Clin North Am. 2000 Feb. 18(1):85-113, vi. [Medline].

Bouillon R. How effective is nutritional supplementation for the prevention of stress fractures in female military recruits?. Nat Clin Pract Endocrinol Metab. 2008 Sep. 4 (9):486-7. [Medline].

Goolsby MA, Boniquit N. Bone Health in Athletes: The Role of Exercise, Nutrition, and Hormones. Sports Health. 2016 Nov 7. [Medline].

Lappe J, Cullen D, Haynatzki G, Recker R, Ahlf R, Thompson K. Calcium and vitamin d supplementation decreases incidence of stress fractures in female navy recruits. J Bone Miner Res. 2008 May. 23 (5):741-9. [Medline].

Tenforde AS, Sayres LC, Sainani KL, Fredericson M. Evaluating the relationship of calcium and vitamin D in the prevention of stress fracture injuries in the young athlete: a review of the literature. PM R. 2010 Oct. 2 (10):945-9. [Medline].

Michael J Ameres, MD Consulting Staff, Department of Emergency Medicine, Southampton Hospital, Adjunct Clinical Assistant Professor, New York College of Osteopathic Medicine

Michael J Ameres, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association

Disclosure: Nothing to disclose.

Benson Yeh, MD Vice President, Designated Institutional Official, Chief Academic Officer, Program Director, Department of Emergency Medicine, The Brooklyn Hospital Center; Clinical Assistant Professor of Emergency Medicine in Medicine, Weill-Cornell Medical School

Benson Yeh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Emergency Medicine, New York Academy of Medicine, Society for Academic Emergency Medicine, Council of Emergency Medicine Residency Directors

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Andrew L Sherman, MD, MS Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, University of Miami, Leonard A Miller School of Medicine

Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, Florida Society of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Rafat Farouqui, MBBS Consulting Staff, Department of Orthopedic Surgery, Brooklyn Hospital Center

Disclosure: Nothing to disclose.

Greg Montalbano, MD Assistant Clinical Professor, Department of Orthopaedics, New York University Medical School

Greg Montalbano, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Sierra Cascade Trauma Society

Disclosure: Nothing to disclose.

Navicular Fracture

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