Rare case of bilateral isolated navicular fractures in an athlete

© BMJ Publishing Group Limited 2022. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION A man in his late teens presented to the orthopaedic trauma clinic with bilateral navicular fractures. He (a highlevel athlete) had reported progressively worsening bilateral midfoot pain, likely as a result of repetitive navicular load. Although he was struggling, he continued to play for approximately six more months. At that point, he was in significant pain and rested both of his feet, mobilising in a wheelchair for four weeks. He tried to play again, however could not continue on. CT scans of both feet showed bilateral fractures of the lateral aspects of the navicular bones with no evidence of collapse. On examination, he was found to have bilateral cavus feet with no swelling or tenderness along the navicular bones. He exhibited significant tightness of the gastrocnemius muscles with a positive Silfverskold test bilaterally. He underwent open reduction internal fixation of the right navicular through a sinus tarsi approach with a single 3mm cannulated compression screw, and there were no significant perioperative complications (figure 1). He was initially nonweightbearing for six weeks and his postoperative course was uncomplicated. He underwent the same procedure for the contralateral side four months later (figure 2). Tarsal navicular fractures make up approximately 5% of all foot fractures, and 35% of midfoot fractures. Acute navicular fractures are commonly a result of either highenergy trauma or repetitive stress. Due to strong surrounding anatomical and ligamentous support structures, this type of injury is generally associated with fractures of the adjacent bones of the foot and rarely happens in isolation. It follows on that simultaneous acute bilateral isolated navicular body fractures are extremely rare, with only one previous case reported in the literature to our knowledge. Acute navicular body fractures occur most commonly as a result of axial loading. They can occur as a progression of a stress fracture. Vertical stress is transmitted through the medial