Navicular avascular necrosis (Köhler disease)
History of intermittent limping left foot pain with inability to bear weight. No history of trauma, fever or systemic illness.
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Irregular sclerosis of the navicular bone ossification center. The appearance is compatible with avascular necrosis of the navicular (Kohler's disease).
There is a long list of possible diagnoses for a limping child. Köhler disease is an unusual one. For this child, clinical examination of the hip, knee and foot was unremarkable. Full blood count and C reactive protein were also normal. Radiographs of pelvis and knee were negative. Finally, it is the foot radiograph that helped to explain this inability to bear weight.
- Stanton BK, Karlin JM, Scurran BL. Köhler's disease. J Am Podiatr Med Assoc. 1992;82 (12): 625-9.