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Observation
16%
681/4168
Open biopsy and curettage
3%
118/4168
Long leg non-walking cast
8%
352/4168
Chopart amputation
0%
5/4168
Short leg walking cast
72%
2990/4168
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The history and radiographs are consistent with Kohler’s disease, avascular necrosis of the tarsal navicular. Köhler suggested that the changes in this disease might be the result of an abnormal strain that acts on a weak navicular, but a definitive answer has not been found. Among the theories to explain the nature of this lesion, a more satisfactory one is a mechanical basis that is associated with a delayed ossification. The navicular is the last tarsal bone to ossify in children. This bone might be compressed between the already ossified talus and the cuneiforms when the child becomes heavier. Compression involves the vessels in central spongy bone, leading to ischemia, which then causes clinical symptoms. Thereafter, the perichondral ring of vessels sends the blood supply, allowing rapid revascularization and formation of new bone. The radial arrangement of the vessels of this bone is of great importance in explaining why the prognosis of this lesion is always excellent. As discussed in the review article by Borges et al. Kohler's disease tends to affect boys more frequently than girls between ages 6-9. Treatment includes immobilization for symptom relief and observation while the navicular re-ossifies.
3.8
(29)
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