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Navicular Stress Fracture
A stress fracture is an overuse injury of the bone and will occur in stages that include initial inflammation, stress changes, and finally stress fracture where the bone will crack to varying degrees. Stress fractures may or may not be visible upon X-ray. The navicular bone is located on the inside of the foot about midway down.
Navicular stress fracture is one of the most common stress fractures seen in sport, especially those involving running and jumping and is even more prevalent in those with flat feet or poor ankle joint range of movement.
James Hird of Essendon Football Club suffered from navicular stress fracture. Symptoms include a chronic vague ache in the mid foot with exercise; pain will quickly decrease with rest. There is usually no history of acute injury. The navicular stress fracture should be quickly managed, as a chronic ‘non-union’ of the stress fracture is common in those poorly managed.
Midtarsal joint Sprain
The midtarsal joints are those that join the small bones in the mid foot together. If the foot is excessively unstable or flat these small joints in the mid foot are prone to strain. These injuries are common in jumping sports such as football and gymnastics. A sharp pain followed by swelling and stiffness is commonly felt in the mid foot with midtarsal joint injury. Ice and rest may help improve prognosis.
Pes cavus is commonly called ‘claw foot’ and is an abnormally high arch underneath the foot present from birth. This condition will tend to involve very stiff joints in the mid foot. Symptoms include excessive force being placed on the toes causing problems such as calluses and permanently bent toes (hammer toe).
This problem is caused by over use of the tendons that pull the toes and foot upwards. This injury can also occur when shoelaces are tied excessively tight causing inflammation of the tendons on the top of the foot. Symptoms include an ache over the top of the foot that increases with activity. Weakness in pulling the toes upwards and pain when walking on heels may also occur.
Plantar Fascia Strain
Plantar facia strains are different to plantar fasciitis in that they involve an acute injury to the plantar facia. The plantar facia is a thick fibrous band that extends underneath the foot from the front of the heel on the inside (medial) aspect and attaching to the underneath of the toes.
This facia provides stability underneath the foot when moving. Acute injury to the plantar fascia will tend to occur during ‘take off’ when sprinting or jumping and will involve a sharp pain under the foot. Pain may increase with weight bearing, with prodding underneath the foot or when pulling the toes upwards.
Early Injury Management
For approximately the first 72 hours following an injury, the RICE regime should be followed to ensure control of inflammation and pain relief.
R - Rest
I – Ice
C - Compression
E – Elevation
Rest from aggravating activity.
Ice should be applied in the first 72 hours or when inflammation persists. Ice should be applied for 15 to 20 minutes at a time. Ice should not be applied directly to the skin, but through a wet towel or cloth.
Compression can be achieved with an elastic bandage.
Elevation is used to help swelling to return to the heart through the blood stream.
The injured area should be elevated above the level of the heart.
Strengthening programs should only be commenced when:
Exercises should be 3 sets of 8-12 repetitions.