The pain was exacerbated by forced ankle dorsiflexion, forefoot inversion, the single-leg hop test, and the toe standing test. There was mild swelling, but no other signs of inflammation. Physical examination revealed focal tenderness over the dorsal aspect of the talonavicular joint, and minimal limitation in the range of motion of the foot and ankle. He was otherwise healthy, with no history of foot trauma or any other diseases. The pain was temporarily relieved with rest for a week and use of analgesics. The patient’s pain worsened while sprinting and kicking a soccer ball with the instep. The patient was a left-footed amateur soccer player, who had participated in 1–2 full-time soccer matches, as well as 2–3-h practice sessions, every week for 7 years. The patient provided written informed consent for the publication of this report and the accompanying images.Ī 34-year-old Asian man presented with a 6-month history of insidious-onset dorsal foot pain that occasionally radiated medially toward the arch. This case report was approved by the Institutional Review Board of Soonchunhyang University Hospital, South Korea (no. Thus, here we report a patient with NSF accompanied by OSSN who achieved bone union through surgical resection. In addition, treatment and bone union outcomes of NSF associated with OSSN have not been reported. reported that the symptoms disappeared after OSSN removal in a patient who visited the hospital for dorsal foot pain, but there was no NSF in this case. They diagnosed using X-ray, CT, MRI, and bone scan, but only inferred the correlation between NSF and OSSN without mentioning conservative treatment or surgery. Ingalls and his colleagues first published a paper on the radiological diagnosis of NSF with OSSN in 2011. Although many studies on the topic of NSF have been published, reports of NSF accompanying OSSN are extremely rare. It is derived from an accessory ossification center, and is found in 1% of the population. Os supranaviculare (OSSN), also called Pirie’s bone, is an accessory ossicle located above the dorsal aspect of the talonavicular joint. The pain is aggravated by running and relieved by rest. Patients complain of vague pain, bruising, and swelling in the dorsal aspect of the midfoot. NSFs are relatively rare, and predominantly affect athletes involved in vigorous jumping, running, and sprinting. The fracture lines are typically oriented sagittally and originate from the dorsal proximal cortex of the navicular bone. Navicular stress fracture (NSF) was first described by Towne et al. Further research is required to evaluate the relationship between NSFs and OSSN, and determine the optimal management of NSFs in patients with OSSN. Because of the fracture gap and biomechanical properties of OSSN, OSSN was excised and the joint was immobilized, leading to a successful outcome. We describe a rare case of NSF accompanied by OSSN. At the 1-year follow-up, the patient’s symptoms had resolved, the American Orthopedic Foot and Ankle Society midfoot score had improved from 61 to 95 points, and the visual analog scale pain score had improved from 6 to 0. The 5-month follow-up CT scan demonstrated definite fracture healing. The OSSN was excised and the joint was immobilized with a non-weight-bearing cast for 6 weeks, followed by gradual weight bearing using a boot. Computed tomography (CT) revealed a sagittally oriented incomplete fracture that extended from the dorsoproximal cortex to the center of the body of the navicular. Plain radiographs of the weight-bearing foot and ankle joints revealed a bilateral, well-corticated OSSN. The pain worsened while sprinting and kicking a soccer ball with the instep, whereas it was temporarily relieved by rest for a week and analgesics. A 34-year-old Asian man presented with a 6-month history of insidious-onset dorsal foot pain that occasionally radiated medially toward the arch. Herein we report the case of a patient with OSSN who was successfully treated for an NSF. There have been few previous reports of NSFs accompanied by OSSN. Os supranaviculare (OSSN) is an accessory ossicle located above the dorsal aspect of the talonavicular joint. Navicular stress fractures (NSFs) are relatively uncommon, and predominantly affect athletes.
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