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"The Curious Case of The Limping Child"

Updated: Dec 12, 2023

4 years old boy presented to the Emergency Department with limping & pain in the left foot of 2 days duration.


His mother denied any history of trauma or falls.


On examination, there was tenderness & mild swelling on the dorsum of the left foot.


Vital signs were all normal.


An X-ray was requested for the affected foot, this was the one


What is your diagnosis?


Discussion:


If you have a careful look at the X-ray above, you will notice that the NAVICULAR bone is sclerotic, fragmented, small, hyperdense & irregular.














Answer:


This was a case of "Kohler disease"

  • It is: a rare idiopathic condition caused by avascular necrosis of navicular bone of unknown aetiology, causing a painful limp, with tenderness on the affected navicular bone.

  • First described: by Dr. Alban Kohler (a German radiologist) in 1908.

  • May be preceded by minor trauma or no history of trauma at all.

  • It is one of the Crushing Osteochondritis.

  • Prevalence: 2%

  • More common in boys (5:1), aged 3-7 years old.

  • Usually Unilateral, but in 25%, it can be bilateral.

  • Here is a comparison between a normal navicular bone (to your right hand side) & a necrotic one (to your left hand side).

Treatment (conservative):

  • Pain control with rest & NSAIDs.

  • If with sever symptoms, consider immobilization using a cast (POP).

  • Orthopaedics follow up.

Prognosis:

  • Excellent, spontaneous resolution occurs within few months (6-48 months), with no reports of long-term disability.

Finally:


Here is a link to a short video that covers the above case:


References:

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