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Mark D Porter
Joseph J Zubak
Winston J WarmeHINDFOOT/MIDFOOTBONYCALCANEALSTRESSFRACTURE- Stress fractures of the calcaneus are relatively rare,
but may be a cause of heel pain in athletes or military
recruits who place significant stress on their heels
(Pester and Smith, 1992). - Calcaneal stress fractures usually present as progres-
sive diffuse pain over the entire heel, not localized
only to the plantar heel. The physical examination is
characterized by tenderness with simultaneous medial
and lateral compression of the calcaneus, and there
may be mild swelling or erythema. Radiographs may
be normal, or a sclerotic vertical band may appear 3 to
4 weeks after the onset of symptoms.
•Technetium bone scan may be necessary particularly
for detection of early cases. - Activity modification is the mainstay of treatment.
Weightbearing is as tolerated with crutches. Anti-
inflammatories and shock-absorbing heel inserts may
be beneficial (Pfeffer, 2001).
NAVICULARSTRESSFRACTURE- Stress fractures of the navicular are being recognized
with increasing frequency in active persons.
Diagnosis is often delayed, and outcome often suffers
because of lack familiarity with the condition.
•Navicular stress fractures typically present in a run-
ning athlete with gradually increasing pain in the
dorsal midfoot with radiation of pain down the medial
arch. Initial plain films are often normal. It may be
necessary to obtain a three-phase bone scan, which is
positive early and localizes the lesion well. After a
positive bone scan, a computed tomographic scan
382 SECTION 4 • MUSCULOSKELETAL PROBLEMS IN THE ATHLETE