The left side of the foot navicular bone is the normal side; the right side of the foot navicular bone lesion Wang Tao, Department of Orthopedics, Affiliated Hospital of Qinghai University Ischemic necrosis of the foot navicular bone (Köhler’s disease)
Definition: A self-healing disease in which the navicular bone of the foot is flattened, sclerotic and irregularly sparse as seen on x-ray.
II Overview.
The incidence is not high mostly in boys (80%); mostly around 5 years of age, 1/3 are bilaterally affected, and ischemic necrosis of the left navicular bone may be accompanied by ischemic necrosis of the femoral head.
Etiology
The etiology of this disease is related to mechanical external force. The navicular bone is the last ossified tarsal bone in the foot bone, it is the apex of the medial longitudinal arch of the foot, the part where the center of gravity is concentrated and the load is great. In its fastest growth stage, if it is injured by trauma or fatigue and squeezed to the ossification center, so that the blood supply into the central artery of the navicular bone is interrupted, it will lead to ischemic necrosis of the navicular bone. Biopsy shows that there are necrotic areas in the navicular bone, and both dead bone resorption and new bone formation are seen.
IV Clinical manifestations
1 Avoidance claudication
2 localized pain, with the child walking on the lateral side of the foot with weight bearing
3 There may be reactive thickening and edema in the local soft tissue, and there may be inflammatory changes at the attachment point of the posterior tibial tendon.
V Treatment
1 Moderate pain: inversion 10-15° plantarflexion 20° walking cast for 6-8 weeks, no weight-bearing walking with double crutches for the first 3 weeks, and weight-bearing walking for the last 3-5 weeks; after removal of the cast, the heel can be padded 0.3 cm higher to relieve weight-bearing strain. Avoid running, jumping and walking long distances.
2 Mild pain or no obvious clinical symptoms: support with longitudinal arch insoles only
VI Prognosis
The prognosis of this disease is good, with repair within 6 months at the earliest, and most patients need 1-3 years.