Navicular

Function

Where it sits

The navicular sits on the inner side of the midfoot¹. The talus (the ankle bone that sits under the shinbone and on top of the heel bone) meets it from behind¹. In front, it meets the three cuneiform bones¹. It is named for its rough boat shape².

Its surfaces

• The back surface is hollowed and meets the head of the talus as a ball-and-socket joint². It does not fully enclose the talar head, which allows movement in several directions².
• The front surface is usually split by two faint ridges into three joint facets, one for each cuneiform².
• The tuberosity is a blunt bony bump at the inner end, pointing down and inward, and it varies in size².

Its place in the arch

One review calls the navicular the keystone of the medial longitudinal arch, the inner lengthwise arch of the foot³. An anatomy textbook explains that the talus receives body weight and sits at the top of the foot’s lengthwise arches¹. Weight then passes to the ground through the front and back ends of those arches¹.

How reviews describe its loading

Reviews describe the forces on the bone in several ways^2,3:

• One review describes lengthwise compression, crosswise tension and sideways shear acting together, concentrated in the narrower, weaker middle of the bone².
• Another describes uneven squeezing from the front³. Forces on the inner side are shared with the talus, while the navicular alone carries those on the outer side³.
• The same review describes repeated compression, as in running, as “bending” the bone at its centre³.
• A third review describes severe compression of the central third in explosive movements such as jumping and sprinting⁹.

A contested blood supply

In an injection study of 60 cadaver legs, branches of the dorsalis pedis artery supplied the top of the navicular⁵.

Sources disagree about the middle of the bone. A review describes vessels entering from each side and branching inward, leaving the central third with relatively little supply³. In the injection study, 30 of 54 specimens had vessels spread throughout the bone⁵. Six had a vessel-free zone in the central third reaching the top surface⁵. Its authors concluded that mechanical or other factors may matter more than previously thought⁵.

Breakdown

Stress fractures of the central third

A review names the navicular as an example of a high-risk stress fracture site³. It says fractures there carry a greater risk of delayed healing, lasting pain and nonunion (a broken bone that fails to join and heal)³. The stress fracture page covers how reviews sort sites by risk.

In a review of CT scans of 55 navicular stress fractures, every fracture involved the central third of the bone’s upper edge¹⁰. A CT scan builds detailed pictures of the inside of the body from X-rays. In the same scans, 96% of the fractures were partial, not complete¹⁰.

Who gets them

A 2021 meta-analysis states that these fractures are rare in the general population but increasingly recognised in athletes⁸. A meta-analysis pools the results of several earlier studies.

Group studied	What was found
180 stress fractures at a Melbourne sports clinic, 2 years	26 were in the navicular, the fourth most common site11
The 54 track athletes in that clinic review	The navicular was the most common site, with 19 fractures11
111 competitive track and field athletes, 12 months	The navicular was the second most common site, with 4 of 26 fractures12
315 fractures in 307 patients, pooled from 11 studies	97% were in athletes, men and women were affected about equally, and the mean age was about 258
The 155 athletes in that pooled analysis with a named sport	52% took part in running activities including track and field, 14% in football and 7% in basketball8

A review reports these fractures mostly in short-distance runners and basketball players³. In the study of 111 track and field athletes, sprints, hurdles and jumps were linked with significantly more stress fractures of the foot¹².

Factors that have been proposed

The authors of the 2021 meta-analysis list factors suggested to predispose the bone to stress injury⁸. These include the path force takes through its inner part and the pull of tibialis posterior (a deep calf muscle)⁸. The poor blood supply of its middle third is another⁸. Studies that looked back at past cases have reported features such as limited ankle dorsiflexion (pulling the foot and toes up toward the shin)¹³. None of those features had been shown to be statistically significant¹³.

One study compared 7 runners with a past navicular stress fracture and 7 matched runners without¹³. During running, the previously injured feet showed more and faster rearfoot eversion (turning the sole of the foot outward)¹³. Ground forces and foot structure did not differ¹³.

Slow to be recognised

In the 2021 meta-analysis, people had symptoms for a pooled mean of 9.9 months before the fracture was identified⁸. A review says people typically report poorly localised midfoot soreness that worsens with weight bearing³. Plain X-rays often miss these fractures, because they are often incomplete or not displaced⁸.

The accessory navicular

An accessory navicular is an extra small bone on the inner side of the foot¹⁴. It forms when a secondary centre of bone growth fails to fuse with the navicular¹⁴. A meta-analysis of 39 studies put its pooled prevalence at 17.5% of patients¹⁴. Most cause no symptoms, and it is usually found by chance¹⁴.

In an ultrasound survey of 875 Japanese children aged 6 to 15, 15.1% had one¹⁵. Of those children, 20.8% had pain from it¹⁵. In a two-year follow-up of 66 children aged 11 to 13, pain had gone in 15 of the 21 feet painful at the start¹⁶.

Navicular drop

Navicular drop is a measure named after the bone. It is the distance the tuberosity moves downward in standing, as the foot goes from a neutral to a relaxed position¹⁷. In 21 healthy young adults, it rose from 10.0 to 11.8 mm after the small muscles of the sole were exercised to fatigue¹⁸.

Studies have tested it against injuries elsewhere in the leg^17,19:

• A meta-analysis found strong evidence that greater navicular drop is a risk factor for medial tibial stress syndrome (shin splints), with a small pooled effect¹⁹.
• The same analysis found no relationship between a pronated (rolled-inward) standing foot posture and bone stress reactions¹⁹.
• Among 287 female team-sport athletes followed over time, navicular drop was not associated with non-contact injury of the anterior cruciate ligament¹⁷.

Recovery

How bone repairs itself

A review explains that ordinary loading causes tiny damage in bone, which remodelling repairs²⁰. The bone tissue page covers that process.

What scans show as it heals

In a review of CT scans, the earliest sign of healing was seen in three of eight fractures scanned at 6 weeks¹⁰. Firm union of the outer bone was present in 10 of 31 by 4 months, and 12 fractures did not unite¹⁰. In a follow-up of 86 fractures in athletes, how a healing fracture looked on CT did not necessarily match clinical union²¹.

In a case series, 7 of 9 people first found to have a navicular stress reaction later showed the features of a stress fracture²². A stress reaction is an early bone stress injury, before a crack forms.

Cast, weight bearing and surgery

In the follow-up of 86 fractures in athletes, 19 of 22 first managed with at least six weeks in a non-weight-bearing cast returned to sport²¹. Of those who first kept bearing weight with limited activity, 9 of 34 returned²¹.

Two pooled analyses of published cases, eleven years apart, point in different directions^7,8.

Two pooled analyses of published cases, eleven years apart, point in different directions.

Pooled analysis	Successful outcomes with surgery	Successful outcomes without surgery	Difference
2010	82%	96%, counting non-weight-bearing management only	Not statistically significant7
2021	96% (104 of 108 fractures)	72% (149 of 207 fractures)	Significant, in favour of surgery8

The 2010 analysis also found that management allowing weight bearing was significantly less effective than either of the other two⁷. The 2021 analysis counted an outcome as successful when the person was pain-free, back at the previous activity level and had no repeat fracture⁸.

The 2021 analysis reported further results⁸:

• Return to play followed 97 of 98 fractures managed with surgery and 152 of 207 managed without; the difference was not statistically significant⁸.
• Time to return had a pooled mean of 4.17 months after surgery and 4.67 months without, with no significant difference⁸.
• Nonunion was reported for 3 of 94 fractures managed with surgery and 33 of 153 managed without⁸.
• Repeat fracture was reported for 1 of 78 fractures managed with surgery and 20 of 85 managed without⁸.

Longer follow-up

In 62 navicular stress fractures in athletes, 57 were followed by a return to activity at the pre-injury level²⁴. Seven fractured again, mostly in athletes under 21, none of whom had had surgery²⁴.

One study looked at 32 fractures more than two years after a non-weight-bearing cast or surgical fixation²⁵. It found no significant differences between the two in current pain, function or CT findings²⁵. Some pain and loss of function remained, small but measurable²⁵.

Connections

Joints and ligaments

The navicular forms the inner half of the midtarsal joint². A review lists the main ligaments around it, among them the dorsal talonavicular ligament and the spring ligament complex². The spring ligament spans the gap between the calcaneus (heel bone) and the navicular, holding up the head of the talus². The deltoid ligament of the inner ankle also reaches the navicular²⁶.

In front, the navicular is compressed through the joints between the cuneiforms and the first and second metatarsals³.

The tibialis posterior tendon

The tibialis posterior tendon has its main footprint on the underside of the navicular². In a dissection study of 41 specimens, its main insertion was on the navicular in all 41²⁷. A review describes its contraction as raising the stress on the inner part of the bone³. The spring ligament is described as working with this tendon to steady the foot in standing and walking².

Exercise

Related exercise pages: running, in which a review describes repeated compression concentrating force at the centre of the bone³.

Sources

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Every source the library cites

Changes

• October 5, 2026 First published.