summary Kohler's Disease is a rare idiopathic condition caused by avascular necrosis of the navicular bone that occurs in young children and presents with pain on the dorsal and medial surface of the foot. Diagnosis is made with radiographs of the foot showing sclerosis, fragmentation, and flattening of tarsal navicular bone. Treatment is usually nonoperative with NSAIDs and a short period of cast immobilization as the condition typically resolves over time. Epidemiology Demographics occurs in young children (usually age 4-7 yrs) four times more common in boys than girls 80% of cases in boys Anatomic locations can be bilateral in up to 25% of cases Etiology 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 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 Prognosis Typically a self-limiting condition Intermittent symptoms for 1-3 years after diagnosis typically associated with activity
QUESTIONS 1 of 8 1 2 3 4 5 6 7 8 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (SBQ18FA.46) A 7-year-old boy presents with 3-week history of pain in the dorsomedial midfoot, which is improved with rest. A foot radiograph is obtained and depicted in Figure A. He is placed in a short-leg cast and is made non-weight-bearing for 6 weeks. This treatment completely alleviates his symptoms. Regarding his pathology, which of the following is most accurate? QID: 211605 FIGURES: A Type & Select Correct Answer 1 Plain radiographs will show cyst formation, fragmentation, and widening of tarsal navicular 9% (146/1628) 2 The bone affected is the first tarsal bone to ossify 9% (149/1628) 3 Core decompression is indicated in the majority of cases 1% (16/1628) 4 Theorized etiology is mechanical compression of the navicular from the ossified talus and cuneiforms 79% (1291/1628) 5 When compared to a short-leg cast, immobilization in a long-leg cast results in quicker return to activity 1% (16/1628) N/A Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic 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? QID: 495 FIGURES: A B Type & Select Correct Answer 1 Observation 16% (649/3946) 2 Open biopsy and curettage 3% (114/3946) 3 Long leg non-walking cast 9% (344/3946) 4 Chopart amputation 0% (3/3946) 5 Short leg walking cast 71% (2818/3946) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07PE.70) A 5-year-old boy has had pain in the right foot for the past month. Examination reveals tenderness and mild swelling in the region of the tarsal navicular. Radiographs are shown in Figure 30. Management should consist of QID: 6130 FIGURES: A Type & Select Correct Answer 1 biopsy of the tarsal navicular. 2% (13/539) 2 curettage and bone grafting of the tarsal navicular. 4% (24/539) 3 CBC count, C-reactive protein level, erythrocyte sedimentation rate, blood cultures, and IV antibiotics. 7% (37/539) 4 symptomatic treatment with restriction of weight bearing or application of short leg cast. 84% (451/539) 5 medial column lengthening of the foot through the tarsal navicular. 2% (13/539) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? QID: 128 FIGURES: A B Type & Select Correct Answer 1 core decompression 12% (178/1455) 2 triple arthrodesis 2% (27/1455) 3 subtalar fusion 2% (24/1455) 4 IV antibiotics with irrigation and debridement 4% (52/1455) 5 short-leg walking cast 80% (1163/1455) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic
All Videos (0) Podcasts (1) Pediatrics⎪Kohler's Disease Orthobullets Team Pediatrics - Kohler's Disease Listen Now 11:52 min 4/20/2020 358 plays 5.0 (2)