Expert running physios in Surry Hills, Sydney, explain how to diagnose and treat navicular bone stress injury for runners.
Running is one of the most rewarding forms of exercise — but it also places high, repetitive loads through the feet and lower legs. One of the most serious causes of foot pain with running is a navicular bone stress injury or navicular stress fracture.
This guide explains what the navicular bone is, why it’s considered a high-risk injury site for runners, and how physiotherapy plays a vital role in effective diagnosis, management, and long-term recovery.
What Is the Navicular Bone?
The navicular is one of the small tarsal bones in your midfoot. It sits on the inside of the foot, just in front of the ankle bone (the talus), and forms an essential part of your foot’s medial arch.
During running, jumping, or hopping, the navicular bone helps transmit load from your ankle through to your forefoot. Because of this, it experiences significant stress during both push-off and landing — especially in runners who train frequently or increase their training loads too quickly.
Why the Navicular Is a High-Risk Site for Bone Stress
The navicular is classified as a high-risk bone stress injury site for two main reasons:
1. High Biomechanical Load: The navicular absorbs and transfers force during every stride.
2. Limited Blood Supply: The central portion of the bone has relatively poor circulation, which slows down the healing process.
This combination increases the risk of navicular stress fractures failing to heal (non-union) or developing avascular necrosis, where the bone loses its blood supply and begins to deteriorate.
Although navicular bone stress injuries account for around 25% of all stress fractures, they are frequently misdiagnosed, often taking months before the correct diagnosis is made.
Common Symptoms Runners Should Watch For
Runners often describe navicular bone stress pain as vague or dull, located over the midfoot or inner arch. Typical warning signs include:
- Gradual onset of pain across the top or inner side of the foot (often called the “N-spot”)
- Pain that worsens during running and eases with rest
- Little or no visible swelling or bruising
- Hop test pain: navicular pain can often be felt with both or either of the press off phase or the landing phase of the hop
- Pain appearing earlier in a run as the injury worsens
If you’re experiencing persistent foot pain with running, don’t ignore it — early diagnosis makes a huge difference in recovery.
Risk Factors for Navicular Bone Stress
Several factors increase the likelihood of developing a navicular bone stress injury or navicular stress fracture:
- Training errors: rapid increase in volume, intensity, or frequency of training
- Gender: although females with nutritional or menstrual disorders are at increased risk of developing stress fractures, young males tend to have higher rates of navicular stress fractures
- Bone density: individuals with lower bone mineral density such as osteoporosis or osteopenia
- Nutrition and Low energy availability: recent significant loss of weight or inadequate calorie intake relative to energy expenditure during exercise. Individuals may be previously diagnosed with Relative Energy Deficiency in Sport (RED-S)
- Previous history of stress fractures: A history of stress fractures can make you 6x more likely to have a second injury if the underlying causes are not addressed
- High-Impact Sports: Athletes in sports with explosive, repetitive jumping, cutting, and rapid changes of direction—like basketball, sprinting, and dancing
Diagnosis and Imaging For Navicular Bone Stress Injuries
If you suspect a navicular bone stress injury, your first step should be an assessment with a physio experienced in navicular bone injuries.
Your physiotherapist will take a thorough history, assess your foot and running mechanics, and if bone stress is suspected, refer for imaging.
- MRI is the gold standard for detecting early bone stress injuries before a full fracture develops.
- CT scans are often used to assess the severity and guide treatment.
Bone stress injuries are graded using systems such as the Fredericson Classification (for severity) an
Physiotherapy Management for Navicular Bone Stress
The management of a navicular bone stress injury depends on the grade and severity of the injury, as well as individual factors like training load, biomechanics, and goals.
Early-Stage Management
Lower-Grade Injuries (Fredericson 1–2 / Saxena 0.5)
- Typically treated conservatively with rest and immobilisation in a walking boot for 6–8 weeks.
- Gradual transition out of the boot with guided strength training.
- Ongoing physiotherapy to rebuild foot and calf strength and safely return to activity.
Higher-Grade Injuries (Fredericson 3–4 / Saxena 1–3)
- Usually require a period of non-weight bearing in a boot and crutches for 6–8 weeks.
- If healing is slow or incomplete, surgical fixation (ORIF with compression screw) may be needed.
- Post-surgery rehabilitation involves progressive loading guided by your physiotherapist.
Later-Stage Management and Return to Running
Once pain-free and imaging confirms healing, your physio will guide you through:
- Strength and Conditioning: Targeting the intrinsic and extrinsic foot muscles, calves, and posterior tibialis to restore stability and load tolerance.
- Biomechanical Retraining: Addressing movement control, mobility, and running technique.
- Gradual Return to Running: Starting with pool running or an anti-gravity treadmill, progressing through a structured walk-run plan.
- Sport-Specific Progression: Only returning to sprinting, cutting, or high-impact sport once pain-free with confirmed bone healing.
How To Reduce The Risk Of Navicular Bone Stress Injury In Runners
Key prevention strategies include:
- Progressive training programs with gradual load increases & adequate recovery
- Optimised nutrition and recovery to promote bone health
- Tailored strength and conditioning plans
- Correcting running gait and wearing appropriate running shoes
Working with an experienced running physio is one of the most effective ways to prevent navicular bone stress and other overuse injuries. At Central Performance, our physios combine biomechanical assessment, load management, and targeted strength training to help runners train safely and consistently.
When to See a Physio for Navicular Bone Pain
If you’re experiencing foot pain with running, particularly across the midfoot or arch, see a physiotherapist who is experienced in diagnosing and managing navicular bone stress injuries. Early diagnosis can prevent a stress reaction from developing into a full fracture — greatly improving your chance of a smooth recovery, reducing your recovery time and helping you stay active.
FAQs About Navicular Bone Stress in Runners
1. How can a physio help treat a navicular stress fracture?
A physiotherapist will assess your biomechanics, guide your recovery plan, manage your load, and progressively restore strength. They coordinate with sports doctors for imaging and ensure a safe return to running.
2. How long does it take to recover from a navicular bone stress injury?
Recovery can take 3–6 months depending on the grade. Early diagnosis and correct management dramatically reduces recovery time and improves outcomes.
3. Should I stop running if I have navicular pain?
Yes. Continuing to run on a navicular bone stress injury increases the risk of a full fracture. Stop running and book an assessment with a physio immediately.
4. Do all navicular stress fractures need surgery?
No. Lower-grade injuries often heal with conservative management under physiotherapy supervision. Surgery is usually reserved for higher-grade or non-healing fractures.
5. How can I prevent navicular bone stress injuries?
Follow a structured running plan, avoid sudden load spikes, maintain good nutrition, and include foot and calf strengthening exercises prescribed by your physio.
6. When can I safely return to running after a navicular stress fracture?
Only after being pain-free with normal activities, regaining full strength, and having clinical tests such as palpation and hop tests become pain-free, can you return to running. Your physiotherapist will guide your return through a graded running program.
Get Expert Physio Support for Navicular Bone Stress Injuries in Sydney
At Central Performance, our team of experienced running physios have years of expertise managing bone stress injuries — particularly navicular bone stress and stress fractures. Our Surry Hills Running Centre combines physiotherapy, exercise physiology, and running coaching to help runners recover fully, prevent recurrence, and return to running stronger than ever.
For more information call us on 9280 2322 or click below to book a running physio appointment or ask a question
