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Findings The radiographs of 2014 demonstrate sclerosis and a flattening/fragmentation particularly about the dorsum of the navicular. The MRI of 2014 demonstrates marrow edema pattern and fragmentation centered about the dorsum and more central portion of the navicular. The marking capsule indicates the pain is about the dorsal/medial aspect of the midfoot. Subsequent radiographs of 2015 and MRI of 2017 demonstrate a reconstitution of essentially normal architecture of the navicular. No residual fragmentation or deformity is present.
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Diagnosis: Kohler’s Disease Kohler’s disease is an avascular necrosis of the tarsal navicular. It typically presents with dorsal medial pain of the midfoot and most frequently involves children from ages 3-7. It is much more common in boys than girls. Related to the vascularity of the navicular, the dorsal/central portion of the bone is involved. The bone is sclerotic and fragmented but almost invariably reconstitutes into a normal or nearly normal navicular. Conservative measures are adequate with resolution typically occurring within 1 to 3 years following diagnosis.
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References Köhler Disease: Avascular Necrosis in the Child. Jeremy Y Chan, Jeffrey L Young. Foot Ankle Clin. 2019 Mar;24(1):83-88. doi: 10.1016/j.fcl.2018.09.005. Epub 2018 Dec 10.
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