Summary

Navicular injuries were associated with both a significant increase in the probability of not being drafted as well as a significant decrease in the likelihood of competing in at least two NFL seasons when compared to matched controls.

Abstract

Background

Navicular injuries can result in persistent pain, post-traumatic osteoarthritis, and diminished performance and function. The purposes of this study were to determine the epidemiology of navicular fractures in players participating in the NFL Scouting Combine and evaluate the impact of a navicular injury on NFL draft position and NFL game play compared to matched controls.

Methods

Data was collected on players who previously sustained a navicular injury and participated in the NFL Scouting Combine between 2009 and 2015. The epidemiology of navicular injuries was determined through evaluation of the number of injuries, surgeries and collegiate games missed, as well as position played, physical examination, surgical technique, and imaging findings. Players with a previous navicular injury (2009-2013) were compared to a set of matched controls. NFL performance outcomes included draft position, career length =2 years, and number of games played and started within the first 2 years of NFL career.

Results

Between 2009 and 2015, 14/2285 (0.6%) players were identified as having navicular injuries. A total of 11/14 (79%) athletes had sustained an overt navicular fracture, while 3/14 (21%) were diagnosed with stress reactions on MRI. Eight patients who sustained a navicular fracture had surgery. There was evidence of ipsilateral talonavicular arthritis in 75% of players with a navicular fracture versus only 60% in the uninjured foot (Odds ratio = 1.3, p=0.04). Fifty-seven percent of players with navicular injuries (72.7% of fractures) were undrafted versus 30.9% in the control group (P< 0.001). When compared to controls, 29% of players with navicular fractures played = 2 years in the NFL compared to 69.6% in the control group (P< 0.01).

Conclusion

A previous navicular fracture results in a greater risk of developing post-traumatic osteoarthritis. Moreover, navicular injuries were associated with both a significant increase in the probability of not being drafted as well as a significant decrease in the likelihood of competing in at least two NFL seasons when compared to matched controls.