Virginia Via Research Day Book 2026

Medical Student Research Case Reports

51 DELAYED DIAGNOSIS OF A NAVICULAR STRESS FRACTURE IN A COLLEGIATE SPRINTER: THE IMPORTANCE OF SUBTLE IMAGING FINDINGS AND HIGH CLINICAL SUSPICION

Jash Patel, B.S., OMS-II; Brett Brodsky, D.O.; Mary Mitchell, D.O.; J. Clements, D.P.M.; Mark Rogers, D.O.; Destini Kruse, A.T.C.; Jen Walker, A.T.C. Corresponding author: jpatel06@vcom.edu

VCOM-Virginia, Blacksburg, Virginia

his symptoms to mild stiffness. With improvement, he resumed sprinting; however, during a high-level USA competition he felt a distinct pop in his right foot, followed by recurrence of anterior ankle and midfoot pain—suspected to represent the moment the navicular cracked. Ultrasound evaluation afterward demonstrated a small effusion at the talar neck. A second MRI showed persistent navicular marrow edema, a tibiotalar joint effusion, deltoid ligament sprain, and extensor tendon inflammation with no discrete fracture line. A corticosteroid injection and aspiration of the tibiotalar joint were performed, yielding only transient improvement. A second CT scan was ordered and demonstrated a dorsal proximal navicular fracture lucency with adjacent sclerosis, consistent with a navicular stress fracture. In consultation with the surgical team, and given the athlete’s desire to return for the outdoor season, operative fixation was recommended. The patient underwent open reduction and internal fixation with two titanium screws. He is currently recovering in the postoperative period and preparing for a targeted return for the outdoor track season.

Context: Navicular stress fractures are high-risk injuries in running athletes due to limited vascular supply leading to risk of avascular necrosis. Delayed diagnosis is common due to subtle imaging findings and may significantly affect return-to-sport timelines. This case highlights the importance of maintaining a high index of suspicion and utilizing appropriate imaging modalities when initial studies are inconclusive. Report of Case: A 21-year-old male collegiate sprinter presented with right dorsal midfoot pain beginning after competition. Initial examination revealed tenderness over the dorsal aspect of the third metatarsal and extensor digitorum tendons. Radiographs were negative for acute fracture but showed subtle cortical irregularities. Magnetic Resonance Imaging (MRI) performed three days later demonstrated stress reactions in the third and fourth metatarsals and edema within the navicular, though full visualization of the navicular was limited. A subsequent computed tomography (CT) scan showed no fracture. The athlete was managed conservatively with a carbon-fiber plate, structured rehabilitation, and osteopathic manipulative treatment, which reduced

Comments: Navicular stress fractures account for up to 35% of stress fractures in sprinters and are notoriously difficult to diagnose early because initial radiographs and CT scans may be falsely negative due to the orientation of the fracture line and the bone’s complex anatomy. The central third of the navicular is relatively avascular, predisposing to delayed healing and nonunion. MRI is the most sensitive modality for early detection of stress reactions, with marrow edema serving as an important early warning sign, though CT is superior for delineating a true fracture line. This case parallels findings in a recent meta-analysis demonstrating that persistent navicular edema on MRI should prompt advanced imaging with CT, even when prior CT is negative. Surgical fixation is often favored in competitive athletes to minimize risk of delayed union and reduce time to return to sport compared to conservative management. Diagnosis: Right navicular stress fracture confirmed on a second CT scan after initially negative radiographs, MRI, and first CT scans.

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2026 Research Recognition Day