Introduction
- Self-limiting idiopathic osteonecrosis of the navicular
- 4:1 male to female ratio
- Presents between the ages of 2 and 9 years.
Natural History
- Self-limiting condition
- Almost all have a radiographically normal navicular at long term follow up after nonoperative management
Patient History and Physical Findings
History:
- Patient complains of midfoot pain and has a painful limp
Physical exam:
- Patient tends to walk on the lateral border of the foot
- The navicular is tender to palpation
Imaging and Diagnostic Studies
A sclerotic, fragmented, and narrowed navicular will be seen on plain radiographs.
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One may also consider bone scan or MRI if radiographs are normal and a strong suspicion exists.
Differential Diagnosis
- Muller-Weiss disease is adult-onset navicular osteonecrosis (aka Brailsford disease).
- Accessory navicular
- Tarsal coalition
Treatment
- Activity modification, soft arch supports
- Treatment in a walking cast provides earlier resolution of symptoms
- Protected weight bearing does not affect outcome
