Intraosseous and Extraosseous Arterial Anatomy of the Adult Navicular

Abstract

If diminished vascular supply is a contributing factor to navicular stress fracture, our results suggest that a relatively small proportion of individuals is prone to their development. Biomechanical or other clinical factors may play a more prominent role in the development of navicular stress fractures than previously suspected.

Vascular foramina of navicular bone: a morphometric study

“…Golano et al [3] also showed osteonecrosis or stress fractures can affect the navicular bone because of its poor vascularization, especially in its central portion. But, a study done by McKeon et al [17] on vascularity of navicular bone using modified Spälteholz technique showed that the navicle had a dense intraosseous vascular supply throughout and only 11% bones had an avascular central zone.…”

Medial-sided Stress Fractures: Medial Malleolus and Navicular Stress Fractures

“…Therefore, the stresses are concentrated in the relatively least vascular area of the bone. This arterial anatomy has since been in question, as McKeon et al 8 found a dense intraosseous vascular supply in most adult cadaveric specimens, which may indicate that other biomechanical or other risk factors may predispose the navicular to a stress injury.…”

“…The dorsalis pedis and posterior tibial arteries supply blood to the navicular bone. 8 The zone of avascularity in the central one-third of the bone was first described by Waugh 9 in a study of adolescents. Therefore, the stresses are concentrated in the relatively least vascular area of the bone.…”

Stress fractures of the foot and ankle

“…A mean delay of four months between the onset of symptoms and diagnosis demonstrates the difficulty of making the diagnosis, likely contributed to by a 66% false negative rate on plain X-rays and the need for CT or MRI [28]. Physiologically the navicular may be predisposed to stress fractures through the presence of a relatively avascular watershed in the central third of the bone, although cadaveric examinations have questioned the significance of this finding [29].…”