Introduction Avascular necrosis of the navicular bone of unclear etiology Epidemiology demographics occurs in young children (usually age 4-7 yrs) four times more common in boys than girls 80% of cases in boys locations can be bilateral in up to 25% of cases Pathophysiology the blood supply of the central one third of the navicular is a watershed zone accounts for the susceptibility to avascular necrosis and stress fractures the navicular is the last bone to ossify increases its vulnerability to mechanical compression and injury Associated conditions infection Kohler's disease is often misdiagnosed as infection Prognosis typically a self-limiting condition intermittent symptoms for 1-3 years after diagnosis typically associated with activity Classification There is no widely used classification system for this condition Presentation History patient may not have complaints as disease can be asymptomatic characteristically described as midfoot pain with an associated limp Symptoms pain in dorsomedial midfoot may have swelling, warmth, and redness point tenderness over the navicular Physical exam antalgic limp (may place weight on lateral side of foot) Imaging Radiographs characteristic sclerosis, fragmentation, and flattening of tarsal navicular most tarsal navicular bones reorganize after disease has run its course some continue to be deformed but almost all of those remain asymptomatic Treatment Nonoperative NSAIDs short course can be used to decrease symptoms immobilization with short leg walking cast indications pain with activities outcomes studies have shown treatment in a short leg walking cast will decrease the duration of symptoms radiographs improve at around 6-48 months from onset of symptoms no reports of long-term disability Operative surgery indications not indicated for this disease
QUESTIONS 1 of 5 1 2 3 4 5 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ08.109) A 6-year-old boy presents to your office with foot pain that is increasing in severity. His parents state he has recently been limping. There is no history of trauma and he is otherwise healthy. Radiographs are shown in Figures A and B. Which of the following is the most appropriate treatment for this child? Review Topic QID: 495 FIGURES: A B 1 Observation 17% (536/3191) 2 Open biopsy and curettage 3% (98/3191) 3 Long leg non-walking cast 9% (286/3191) 4 Chopart amputation 0% (1/3191) 5 Short leg walking cast 71% (2258/3191) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 5 (OBQ04.17) A 5-year-old boy presents with a limp and pain over the medial aspect of the foot. Radiographs are shown in figures A and B. Orthotics have failed to improve his symptoms. What is the next appropriate management of this condition? Review Topic QID: 128 FIGURES: A B 1 core decompression 14% (139/994) 2 triple arthrodesis 2% (21/994) 3 subtalar fusion 2% (16/994) 4 IV antibiotics with irrigation and debridement 3% (30/994) 5 short-leg walking cast 79% (781/994) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 5