Navicular Stress Fracture misdiagnosed?????

The specificity of an MRI detecting a stress fracture - its ability to correctly identify a "negative" result - is over 90%, but it's not 100%. Get another MRI, or get a bone scan. If you have to, just go to another doctor at another clinic and don't mention the first MRI.

Usually I wouldn't recommend this, but a navicular stress fracture is "high risk" meaning it is prone to incomplete healing and long-term problems if it's not taken care of properly. So don't mess with it.

A bone scan is a better diagnostic test. Unfortunately MRI and Bone Scans are expensive and you're not going to get either covered unless your doctor orders it. Depending on your insurance, a doctor may even have a disincentive to order one for you. That doesn't mean you can't ask.

I had poster tibilal tendinities some years back, and it hurt badly in the navicular spot, so it could very well be tendinitis.I don't have data, but I'd imagine it's much more common than a stress fracture.

I had a navicular stress fracture and it was only diagnosed after a CT scan. I had an x-ray and then an MRI and then a CT scan. Not sure if you can get a third opinion with a sports doctor?

Thanks for the suggestions. I think I really need a CT done. Bone scan is good but from what I hear it doesn't show you the extent of the fracture if there is one. Unfortunately though I woke up this morning and took a step and felt extreme pain and it immediately swelled up and started bruising so I think something is definitely wrong. So I called the doctors secretary the one I first went to and left a message so hopefully they'll be able to see me today. In the mean time I am on crutches since It is incredibly hard to walk on. Plus I really don't want to mess up this foot if it is the navicular bone. Hopefully they do more testing soon to figure this out. Really frustrating just constantly being in pain and not figuring out the problem. However the first doctor does sports injuries and loves running himself so I'm hoping he'll be able to figure this out.

Sorry to hear about your foot pain. It sounds like it has been a very frustrating process for you thus far.

Please dont listen to the above poster suggesting you goto another doc and dont mention the previous MRI. Some cases are more difficult than others and the docs need a clear picture to aid in diagnosis.

How old are you? Did this pain start from trauma or just randomly start hurting? Have you changed shoes recently? Did the boot relieve pain while you were in it? Did physical therapy help the pain? Do ibuprofuen or any NSAIDs help it? Any symptoms on the opposite side?

The fact that it hurts more when youre on your toes could mean posterior tibial tendinitis. The post tib has a main insertion on the navicular and its not uncommon for pain to develop at that location. Im assuming they took Xrays---sometimes an accessory ossicle or bone can be present and cause severe pain at the navicular and often needs to surgically be removed--usually presents symptomically in teens though. Stress fx is also concerning. I would go with a CT over a bone scan to show you the exact extend of the injury if there is one to the bone.

Feel free to ask any more questions.

Thanks for the reply. I am 23. It started randomly while running. got new shoes a couple months ago but laces aren't tight or anything. The boot helped take the edge off but not greatly. ibuprofen does not help. other foot is perfectly fine. Although, I did injure my foot with a weird step today and its extremely swollen and black and blue. doctor just said physical therapy which is crazy since i can't even stand or even walk on the foot. Does tendonitis cause you to wake up in the middle of the night with foot pain?

I'm thinking just go to physical therapy evaluation and get their opinion and if they think i need to see a doctor and get imaging i will look for a great sports injury orthopedic doctor. The best way i can describe the pain is like someone stuck a screw in my bone and tightened it really tight like its about to explode. a bad pressure pain and kind of achy. worse at night and while I'm sleeping. hard floors and barefoot is worse. first step out of the boot on wood floor is very painful when i do wear the boot.

FWIW, I had a navicular coalition (i.e. the navicular was congenitally fused to some other bone, I think) and it presented pretty similar to what you describe. If I remember right, the lack of movement in the navicular was causing some kind of rubbing inside my foot, with effects very similar to arthritis (or maybe just arthritis). Had to have it surgically repaired (I think they basically went in a "cut" it apart) and I missed entire XC and track seasons my junior year of HS. I came back strong senior year and ran D1 in college, and while I've had plenty of other injuries over the years, I've never had problems with my foot since then. Pretty rare to have this I think, but might be worth asking about if your docs can't figure out what you have. I had to see a few before someone diagnosed it properly.

The specificity of an MRI for a stress fracture is over 90% but the sensitivity is only 72% according to this study.

http://www.ncbi.nlm.nih.gov/pubmed/22473075

Sensitivity is more important and a bone scan is the best test for detecting the stress fracture with a sensitity at 92%.

If the bone scan is positive then a CT scan is by far the best test as it is much more specific for bone than an MRI. A rating system for healing was also described in this paper that I co-authored with Dr Amol Saxena

http://www.ncbi.nlm.nih.gov/pubmed/10789100

You also need to be completely non weight bearing, just being the in the boot is not enough. Khan, et al in Australia set the gold standard for conservative treatment:

http://www.ncbi.nlm.nih.gov/pubmed/1456359

Good luck

Dr Brian Fullem

Wouldn't an MRI pick up a fused navicular?

Also, was your MRI completely negative of anything whatsoever?Even for swelling in the area?

Another possibility is subluxation/disarticulation (slightly dislocated) of the navicular, which may be subtle enough not show up on an MRI. I'm unsure of exactly how painful that would be, though.

Whatever it is, you need to treat this like a stress fracture until a doctor gives you a firm diagnosis. As said above, go completely non-weight baring.

There was swelling in the area of navicular. but near the surface only. not inside the bone though. No other findings on MRI like tendonitis or anything. I'm just going to try to go to physical therapy and get their opinion and if they think I need another opinion I will look for a good sports orthopedic doctor. I'm not putting much weight right now. I am aware not to walk on the edge of your foot either or you can cause a stress fracture there from all the weight on the outside of the foot. I just don't want to mess up my foot since my career I picked I will have to be on my feet all day constantly. So I agree that I need to treat it like it is a stress fracture. I have to anyways cause my foot is so swollen and bruised that I can't walk without crutches.