Navicular fractures are often the result of high-energy injuries. In athletic injuries, they are most common in jumping sports, like basketball. The patient presents with either immediate or delayed pain.
In the multiply-injured patient, navicular fractures are often overlooked. These injuries are often picked up on the secondary survey. The unconscious patient should be carefully examined for unusual swelling or crepitus. If suspected, foot x-rays are indicated.
Often there is swelling and point tenderness. The split or stress fractures are as a rule not associated with any deformity. The higher-energy injuries (MVA or industrial/crush) are associated not only with marked soft-tissue trauma, but also with other injuries to the foot and deformity is more likely to be present.
Plain x-rays often show a linear fracture line in the central portion of the navicular.
If a fracture is clinically suspected, but not evident on the x-ray, then proceed to other means of imaging. A CT and an MRI may give you a more definitive answer.