Imaging Case of the Week 139

The following right foot x-rays are from a 5 year old with a history of recent onset limp. What can be observed?


right footright foot lateral

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The AP and lateral foot views show a dense and fragmented navicular bone. This is due to avascular necrosis of the navicular bone, also known as Kohler’s disease.

AVN navicular


Avascular necrosis of the navicular bone affects young children between the ages of 4-7; it is purported to be 4x more common in boys than girls and bilateral in 25% of all cases. The child usually presents with mid-foot pain and a limp. It is a self-limiting condition with intermittent symptoms lasting 1-3 years after the initial diagnosis. Infection of the navicular is a differential diagnosis.