Contents
Introduction
Pain & swelling of the medial midfoot with associated osteochondrosis or avascular necrosis of the tarsal navicular.
Eponymous osteochondritis:
Osteochondritis is a painful type of osteochondrosis where the cartilage or bone in a joint is inflamed
- Kienbock disease (lunate)
- Panner’s disease (capitulum)
- Sever’s disease (calcaneum)
- Kohler disease (navicular)
Kohler disease was first described by Alban Kohler in 1908 as an avascular necrosis of the navicular bone.
Pathophysiology
Navicular is the last tarsal bone to ossify and can get compressed between the already ossified talus and cuneiforms when the child becomes heavier. This in turn compresses the navicular bone’s perichondral ring of blood vessels, producing ischemia of the central spongy bone and avascular necrosis. The prognosis remains excellent owing to this radial arrangement of blood supply.
Clinical features
- Dorsomedial midfoot pain
- Physical examination:
- Point tenderness over navicular + redness, warmth, and swelling
- Antalgic limp (walk on lateral side of foot)
Diagnosis
X-ray:
- Collapsed, flat, and radiodense navicular bone
Management
- Pain management
- Soft arch supports or medial heel wedge
- Severe cases: Short leg walking cast (for 4-6 weeks)