Presentation
Right intoeing and difficulty in walking.
Patient Data
Normal radiograph of tarsal and metatarsal bones.
Acroosteolysis mainly affecting the distal phalanx of the big toe.
The patient presented after one year with persistent complaint of right intoeing.
Thinning and diffuse sclerosis of left navicular bone, in keeping with avascular necrosis of the navicular - Kohler disease.
Case Discussion
This case shows the progression of Kohler disease, from normal radiograph to obvious radiological features. It appears as decreased size of navicular bone with diffuse sclerosis in young children below 6 years. It is more common in boys, but girls have a younger age of onset than boys as early as 2 years, as in this case. In untreated patients, symptoms last longer than in treated patients (15 months vs 3 months).
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