Pain in the midfoot, particularly around the navicular bone when walking, is a common complaint that can significantly impact daily mobility. The foot is a complex structure designed to bear the entire weight of the body, and any issue with a weight-bearing component often results in pain during activities like walking. Understanding the function of this bone and the conditions that affect it is the first step toward finding relief.
Understanding the Navicular Bone’s Role
The navicular bone is one of the seven tarsal bones located in the midfoot, situated on the inner side just above the arch. Its name, derived from the Latin word for “little boat,” describes its curved shape, which connects the ankle bone (talus) to the three cuneiform bones leading to the toes. This position makes it a structural linchpin of the foot’s arch.
It functions as the “keystone” of the arch, receiving a significant portion of the body’s weight load from the talus and transferring it forward to the rest of the foot during movement. The posterior tibial tendon, a major stabilizer of the arch, attaches directly to the navicular bone. Because the navicular is central to weight distribution and arch support, any injury or irritation is naturally aggravated by the repetitive forces of walking.
Common Conditions Causing Pain When Walking
Pain originating from the navicular bone during walking is often a sign of increased stress on a structure that is already under constant load.
Navicular Stress Fracture
One frequent cause is a navicular stress fracture, which develops from repetitive microtrauma rather than a single injury. This injury typically presents as a deep ache in the midfoot that worsens with activity and may cause a limp as the condition progresses. The central third of the navicular bone has a naturally poor blood supply, which makes it slow to heal and particularly susceptible to stress fractures.
Posterior Tibial Tendon Dysfunction (PTTD)
Posterior Tibial Tendon Dysfunction (PTTD), often called adult-acquired flatfoot, occurs when the posterior tibial tendon weakens or tears. This tendon attaches to the navicular and supports the arch during walking. When the tendon fails, the arch gradually collapses, placing abnormal stress on the navicular area and causing pain and swelling along the inner side of the ankle and arch.
Accessory Navicular Syndrome
Accessory Navicular Syndrome involves an extra piece of bone, called an accessory navicular, located near the main bone. This congenital condition can become painful if the accessory bone or the attached posterior tibial tendon becomes inflamed due to overuse, trauma, or chronic irritation from footwear. Pain is typically felt as a throbbing in the arch and midfoot, often worsened during or after walking.
Arthritis and Tarsal Coalition
Pain can be caused by arthritis, where the cartilage protecting the joints around the navicular bone wears down. This condition leads to inflammation and pain that is aggravated by prolonged standing and walking. Tarsal coalition, a less common congenital condition where two or more bones in the midfoot are abnormally fused, can also cause rigid flatfoot and pain in the navicular area, sometimes only becoming symptomatic later in life.
Immediate Steps for Pain Management at Home
Managing navicular pain at home focuses on reducing inflammation and limiting mechanical stress.
RICE Protocol and Medication
The RICE protocol is an effective starting point, involving strict rest from weight-bearing activities if the pain is sharp or sudden. Applying ice to the affected area for 15 to 20 minutes several times a day can help minimize swelling and dull the discomfort. Compression and elevation can also help control swelling in the foot, though the primary action should be rest. You should consider using over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to temporarily reduce pain and inflammation. Remember that medication only masks the symptom and does not address the underlying cause.
Footwear Modification
Modifying your footwear is necessary to reduce pressure on the navicular bone and arch. Switching to a stiff-soled shoe with strong arch support can help stabilize the midfoot and reduce the strain on the affected structures. Avoiding flat, unsupportive shoes is crucial, and temporary use of a walking boot or brace may be necessary if a stress fracture or severe tendon issue is suspected. Gentle stretching of the calf and foot muscles can be beneficial if the pain is mild, but any movement that increases pain should be stopped immediately.
Professional Treatment Options and Outlook
If pain persists for more than a week or two, or if you experience an inability to bear weight, significant swelling, or a visible deformity, a medical evaluation is necessary. A specialist, such as a podiatrist or orthopedic surgeon, will typically begin the diagnostic process with a physical examination and may order imaging tests. While standard X-rays can rule out other conditions, a navicular stress fracture often requires more detailed imaging, such as an MRI or CT scan, for definitive diagnosis.
Non-surgical treatments are the first line of defense for most navicular conditions. For a stress fracture, this may involve six to eight weeks of non-weight-bearing immobilization in a cast or specialized boot to allow the bone to heal. PTTD and Accessory Navicular Syndrome are often treated with custom orthotics to provide long-term arch support and reduce excessive strain on the tendon. Physical therapy is often recommended to strengthen the posterior tibial muscle and other surrounding foot and ankle stabilizers once the acute pain subsides.
Surgery is generally reserved for cases that fail to respond to extensive non-surgical management, such as a non-healing stress fracture or advanced PTTD that has caused a significant foot deformity. The outlook for recovery is largely dependent on the underlying condition and the timing of diagnosis. Early diagnosis and strict adherence to a non-weight-bearing protocol for a navicular stress fracture are important to prevent chronic issues and ensure a successful return to activity.