I have a partial tarsal navicular stress fracture of the left foot. I'm in a cast and using crutches, doing everything the surgeon told me. Do partial fractures heal faster than full fractures?
The tarsal bone is between the navicular and the calcaneus (the heel bone). The navicular bone is between the tarsal bone and the toes. It's the one you can feel sticking up the most on top of the foot.
A stress fracture means there is a tiny crack in the bone where pressure from overuse has stressed the bone. There are two main types of navicular stress fractures: complete and incomplete.
As the labels suggest, a partial stress fracture doesn't go all the way through the bone. A complete fracture does go all the way through the bone and can separate forming two pieces of bone where only one previously existed.
Bone takes six to eight weeks to heal in the average, healthy adult. Partial stress fractures may heal in a slightly faster fashion but it will still be about six weeks of recovery time before X-rays show normal bone again.
Patients who have diabetes, heart disease, or other chronic diseases may take a bit longer to heal. Anyone who smokes or uses tobacco products is also likely to find the timetable is stretched out more than average.
The treatment approach can make a difference in recovery, outcomes, and rate of fracture recurrence. Treatment is broken down into two main categories: conservative (nonoperative) and surgical.
Conservative care means the patient's foot and lower leg are put in a cast until the fracture heals -- usually six to eight weeks. Patients treated conservatively use crutches to get around without putting weight on the foot.
Based on X-ray findings, they are gradually allowed to slowly start putting weight on the foot. The radiographs help show the stage of healing. They wear a special weight-bearing boot that protects the healing bone while still allowing some pressure from the ground up.
Surgery is done to help return athletes to their sports activities more quickly. The procedure usually involves an open incision and pins or screws to hold the bone together while healing. Sometimes a bone graft is used to help things along. There's been some question as to whether or not surgery is being done unnecessarily for these injuries.
Studies show that the fastest healing time with the best outcomes are shared by patients who were treated conservatively with a nonweight-bearing approach. Surgery doesn't speed up healing, recovery, or provide a faster return to sports or daily activities.
The nonweight-bearing treatment for tarsal-navicular stress fractures is really the best overall approach. It's possible this type of management could even be done without the cast but specific studies looking at the difference in results between nonweight-bearing with and without immobilization must be done before coming to any firm recommendations about this approach.
Joseph S. Torg, MD, et al. Management of Tarsal Navicular Stress Fractures. In The American Journal of Sports Medicine. May 2010. Vol. 38. No. 5. Pp. 1048-1053.
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