Ortho-Preferred Tracking Pixel
Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Kohler's Disease I



- Discussion:
    - self limiting avasulcar necrosis of the navicular;
    - usually unilateral and affects children, most often boys;
    - onset is at age 4 in boys and age 5 in girls;
    - navicular is subjected to repetitive compressive forces during wt bearing which may be a risk factor for AVN;
           - navicular is last bone in foot to ossify & delayed ossification appears to make the navicular more vulnerable to compressive damage;
           - compressive forces can occlude the vessels of the soft ossification center redering it avascular;
    - prognosis:
           - disease is self limiting & prognosis is excellent;
           - navicular typically regains its normal shape before foot completes growth, and normal ossification is usually completed in two years;


- Clinical Manifestations:
    - painful limp, shifting weight to lateral edge of foot to relieve pressure on longitudinal arch;
    - pain tenderness, and swelling develop in the region of the navicular;
    - contraction of tibialis posterior muscle may be painful;


- Radiologic Findings:
    - navicular shows patchy areas of sclerosis and rarefication w/ loss of normal trabecular pattern;
    - navicular may appear collapsed or in some cases will have normal shape with a uniform increase in density and minimal fragmentation;
    - it is occassionally seen on opposite, asymptomatic foot;


- Treatment:
    - symptomatic treatment is needed for the pain and swelling;
    - soft longitundinal arch supporters, medial heel wedge, and limitation of strenuous activity;
    - if pain is severe or persists, a short leg walking cast may be used for 4 to 6 weeks, followed by use of shoe modifications



 Köhler's disease of the tarsal navicular: long-term follow-up of 12 cases.

 Köhler's disease of the tarsal navicular

 The Ossification and Vascularisation of the Tarsal Navicular and Their Relation to Köhler's Disease.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, April 12, 2012 10:13 am