The diagnosis and treatment of tarsal navicular stress fractures is a perplexing problem for the physician treating the active athlete. Ill-defined symptoms, minimal physical findings, and the lack of specificity of radiographs often lead to delay in diagnosis and implementation of treatment. Both incomplete and complete fractures can occur; complete fractures may be acute or chronic, nondisplaced or displaced; and all of these variants require treatment decisions based on the injury as well as the expectations and needs of the individual athlete. Both nonsurgical care and operative treatment are effective methods of treating stress fractures of the navicular depending on these factors.