Unread postby Spencer Chang, MD » Fri Feb 23, 2007 3:00 pm
Navicular stress fractures are actually probably more common than most people think. Most involve a stress fracture in the sagittal plane and are not displaced. If the fracture is not displaced, this can be treated in a cast or boot. However, the patient needs to be NON-WEIGHTBEARING FOR 6 - 8 WEEKS. Sometimes, the fracture can go on to displace. However, you'll be able to see it on an x-ray, and an MRI or CT is often not needed. I usually get an MRI to rule out a non-displaced navicular stress fracture not seen on x-rays.
Please be careful about Podiatrists. They are not all good, and most are not good at all. I would seek out an Orthopaedic Surgeon who is fellowship trained in Foot and Ankle surgery.
I did my fellowship with Dr. Roger Mann in Oakland, California who wrote the book on Foot and Ankle Surgery. During my 6 months of post graduate specialized training, I would say that perhaps 25% of the cases we saw were screw-ups from Podiatrists. Unfortunately, in California, Podiatrists are allowed to do anything an orthopedist is licensed to do. This makes it very dangerous at times.
The typical lay person thinks that if he/she has a foot problem he/she should see a Podiatrist. Podiatrists are a dime a dozen.
I am generalizing, but most of this is true. Most podiatrists were medical doctor wannabes who wanted to go to medical school but couldn't get in. They're training is less extensive, and they are not required to do further training to do the surgeries that they often do.
On the otherhand, it is very difficult to get into medical school now. So you are talking about the cream of the crop coming out of college. Then, in order to become an orthopaedic surgeon, you have to be the top in your medical school class. On top of that, in order to get a good fellowship in foot and ankle surgery, one needs to be a top resident in orthopaedics. Most orthopaedists fellowship trained in foot and ankle will have had 4 years of medical school, 5 years of orthopedic residency, and 6 - 12 months of additional fellowship training.
Personally, I did 4 years of medical school, 5 years of orthopedic residency with an additional research year (6 years), 1 year of fellowship training in sports medicine, and an additional 6 months of fellowship training in foot and ankle. To become an expert in my field, it took 15.5 years of my life including undergraduate schooling. That's nearly twice as many years of training than a typical Podiatrist would have.
Now consider that Podiatrists get trained by Podiatrists. Even if the training were as extensive as an orthopedic surgeon, podiatrists aren't trained by the best in the field.
In the pole vault, even if you have vaulted for many years, but never got any good training from a knowledgeable coach, chances are you probably would not be as good a pole vaulter as you could be. Obviously talent plays into being a good pole vaulter as well. A Podiatrist is like being a pole vaulter with limited talent being coached by a low level coach.
Also, I can tell you that in general, Podiatrists will try to push their patients into having surgery. Surgery bills more, and they make more money.
Personally, I would be very careful about having a Podiatrist take care of your foot or ankle problems. I would also be careful about having an orthopedic surgeon not fellowship trained in foot and ankle take care of your foot or ankle problem.
Perhaps there are some good Podiatrists out there. My mentor believed that there were no good Podiatrists out there.
Treating a navicular stress fracture in a cast but allowing weightbearing will not allow the fracture to heal. Moreover, 4 weeks is not enough. If the fracture truly was non-displaced, it would have healed with 6 - 8 weeks of non-weightbearing in a cast.
I have treated several athletes on the University of Hawaii track team with navicular stress fractures very successfully with this protocol. I have not had to do surgery on anyone for a navicular stress fracture.
Most, athletes tend to be very toey in their sprints. Look at their sprint mechanics, as that could also be a source and reason for their pain.
Sincerely,
Spencer Chang, M.D.
Orthopedic Surgeon
Fellowship trained in Sports Medicine
Fellowship trained in Foot and Ankle Surgery
University of Hawaii Pole Vault Coach
Check out the video Vault 2000. You may purchase it at SpringCo or On Track.
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