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Navicular Fracture Increases Risk of Osteoarthritis in Elite Football Players

Key findings

  • Navicular fracture is a risk factor for posttraumatic osteoarthritis in elite football players
  • Elite football players with previous navicular fractures were less likely than matched controls to be drafted by the NFL and less likely to play for at least two seasons
  • Navicular fractures might significantly interfere with the ability of other elite athletes to continue to compete at a high level

Tarsal navicular fractures can occur because of acute trauma or from repetitive stress. They may go undiagnosed or be misdiagnosed as tendinitis. Even if treated they can cause significant disability, especially in athletes. Until recently, no study had evaluated the effect of navicular injuries on elite football players.

Gregory Waryasz, MD, foot and ankle surgeon and sports medicine physician, and Christopher W. DiGiovanni, MD, chief of the Foot & Ankle Service at Massachusetts General Hospital, are part of a research team studying the effect of various injuries on the draft status and career performance of players in the National Football League. In the Orthopaedic Journal of Sports Medicine, they report that navicular fractures can be significantly detrimental to the ability of football players—and perhaps other athletes—to perform at an elite level.

As part of the study, the researchers reviewed medical records of 2,285 athletes who participated in the NFL Scouting Combine between 2009 and 2015. That week-long program, comprising a variety of rigorous physical examinations and exercises, allows teams to evaluate top college football players who are considered prospects for the draft.

Fifteen navicular fractures were identified in 14 athletes. Eleven had sustained overt fractures (including a player with bilateral fractures) and three had stress fractures diagnosed on MRI.

Eight of the 11 players with a history of overt fractures had undergone surgery. The player with bilateral fractures had the first one managed nonsurgically and underwent surgery for the contralateral fracture. Two patients treated surgically required revision for nonunion or refracture around the screw.

Radiographs were available for 12 fractures, of which nine were healed or partially healed (defined as residual nonunion or delayed union of the fracture site). There were two nonunions, and one athlete suffered a refracture.

Nine of the 12 radiographs (75%) showed ipsilateral talonavicular arthritis. Ten radiographs were available for the contralateral uninjured foot, of which six (60%) showed osteoarthritis (odds ratio, 1.3; P = .04). The severity of osteoarthritis was not assessed, but the authors say its presence suggests that navicular fractures have substantial long-term implications for progressive midfoot disease.

Performance data were collected for seven players with a history of navicular injury who had competed in at least two NFL seasons. They were compared with a control group of 1,028 players who missed <2 games in college, played the same positions, had not undergone previous surgery and had no documented injury.

These seven players were significantly more likely than controls to have remained undrafted and significantly less likely to have competed in the NFL for at least two years. Likewise, players with navicular fracture played in fewer games in their first two NFL seasons, although the difference between them and the control group was not statistically significant.

The authors note that many moves in sports, such as cutting, sprinting and jumping, can exacerbate the symptoms of a navicular fracture. Thus, such an injury might have a substantial detrimental impact on the ability of any athlete to perform at an elite level.

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