The radiographs show osteonecrosis of the navicular bone, otherwise known as Kohler’s disease. Treatment is traditionally symptomatic and pain usually can be relieved by limiting activities, and using orthotics. If this does not work, then a short leg walking cast for 4-6 weeks would suffice. Surgery is not indicated for this entity since it is self limiting.
DiGiovanni et al review variants of osteonecrosis of the foot in their JAAOS article. They emphasize the radiographic changes of Kohler's disease, including navicular sclerosis, may represent a normal variant in asymptomatic patients; thus, the diagnosis of osteonecrosis must be corroborated by clinical suspicion and supportive radiographs.
Williams et al found all patients were asymptomatic and, with nonsurgical management, had a radiographically normal navicular at 9-year follow-up. Casting provided earlier resolution of symptoms. Weight-bearing status did not affect outcome.
Ippolito et al followed a series of patients for 33 years. They found all patients were asymptomatic at follow up. Weightbearing plaster casts for 3 months rendered the patients pain-free, whereas arch supports only decreased local pain, which lasted for an average of 7 months.
DiGiovanni CW, Patel A, Calfee R, Nickisch F. Osteonecrosis in the foot. J Am Acad Orthop Surg. 2007 Apr;15(4):208-17.
PMID:17426292 (Link to Abstract)
Williams GA, Cowell HR. Köhler's disease of the tarsal navicular. Clin Orthop Relat Res. 1981 Jul-Aug;(158):53-8. PubMed PMID: 7273526.
PMID:7273526 (Link to Abstract)
Ippolito E, Ricciardi Pollini PT, Falez' F. Köhler's disease of the tarsal navicular: long-term follow-up of 12 cases. J Pediatr Orthop. 1984 Aug;4(4):416-7. PubMed PMID: 6432840.
PMID:6432840 (Link to Abstract)