SLR - April 2018 - Blayne K. Patton

Epidemiology of Navicular Injury at the NFL Combine and Their Impact on an Athlete’s Prospective NFL Career

Bryan Vopat, MD, Brendin R. Beaulieu-Jones, BA, Gregory Waryasz, MD, Kevin J. McHale, MD, George Sanchez, BS, Catherine A. Logan, MD, MBA, MSPT, James M. Whalen, ATC, Christopher W. DiGiovanni, MD, Matthew T. Provencher, MD, CAPT, MC, USNR. Epidemiology of Navicular Injury at the NFL Combine and Their Impact on an Athlete’s Prospective NFL Career. Orthopaedic Journal of Sports Medicine. 2017 Aug 18; 5(8).

Scientific Literature Review

Reviewed By: Blayne K. Patton, DPM
Residency Program: Carilion Clinic/Virginia Tech School of Medicine (Roanoke, VA)

Podiatric Relevance: Fractures of the navicular are difficult injuries to diagnose and may ultimately become disabling in the athlete. Patients often present with vague midfoot and ankle pain, which often leads to misdiagnosis at initial presentation. The TN joint accounts for approximately 80 percent of hindfoot motion. If neglected, stress fractures of the navicular may result in fracture propagation and bony resorption. Navicular fractures also have a higher propensity for the development of AVN and or TN joint arthritis. This may result in pain as well as decreased ROM, which can be detrimental to athletic performance. The purpose of this study was to identify the incidence of navicular fractures of athletes competing in the NFL combine as well as to determine the impact of navicular injury on the NFL draft position and NFL game play as compared to matched controls.

Methods: Data was extracted from all players participating in the NFL combine between 2009 and 2015. Those players with a navicular injury between the years of 2009 and 2013 were compared with a set of matched controls. The matched controls consisted of players who missed <2 games in college, played the same position and did not undergo previous surgery or have a documented injury. NFL performance criteria included the draft position, career length >2 years and number of games played and started within the first two years. Epidemiological data included position played, number of college games missed, and treatment methods used. Plain radiography, MRI and CT were used to analyze fracture types as well as TN arthritis.

Results: There were 15 navicular injuries identified in 14 athletes out of a total of 2,285 players who participated in the NFL combine. This produced an incidence of navicular injury in only 0.6 percent. Eleven of 14 (79 percent) athletes suffered overt navicular fractures while three of 14 (21 percent) were diagnosed with navicular stress fractures utilizing MRI. All stress fractures were treated conservatively with immobilization for six weeks. Eight of 11 overt fractures underwent surgery. Fifty-seven percent of players with prior navicular fractures went undrafted compared to only 30.9 percent in the control group. Also, only 28.6 percent of players with a navicular fracture played >2 years in the NFL compared with 69.6 percent of the control group. Offensive players were less likely to get drafted following a navicular injury in comparison to defensive players.

Conclusion: A foot and ankle specialist should have a high index of suspicion for navicular fracture when an athletic patient presents with vague ankle or midfoot pain with or without an incidence of trauma. If misdiagnosed or improperly treated, these injuries can progress and ultimately become detrimental to an athlete’s ability to perform. Even with timely diagnosis and proper treatment, these injuries often lead to posttraumatic arthritis, which can be disabling in the athletic population. In this study, athletes with no prior navicular injury had decreased rates of talonavicular joint arthritis, improved odds of getting drafted and, on average, longer careers. These results can be used to help guide expectations of athletes who want to play sports professionally following a navicular injury.

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