Tarsal Navicular Osteonecrosis in Children

Osteonecrosis (avascular, aseptic or ischemic bone necrosis) of the tarsal navicular in children may develop either spontaneously (primary, idiopathic, atraumatic or non-traumatic) or secondary to trauma (post-traumatic) and osteochondrosis. In both groups, of primary and secondary osteonecrosis, the clinical findings as well as the radiographic abnormalities are self-limited and usually resolve spontaneously irrespective of weight-bearing and immobilization treatment modalities. Köhler’s disease has been defined either as atraumatic navicular osteonecrosis or as an osteochondrosis process, based on the similar radiographic appearance of increased sclerosis and flattening detected in both asymptomatic and symptomatic children. Post-traumatic tarsal navicular osteonecrosis in children may follow microtrauma or overuse injuries, stress fractures, acute fractures, osteochondritis dissecans and severe foot injuries. This editorial aims to present the primary and secondary causes of osteonecrosis of the tarsal navicular in children and to describe the difficulties of the clinical and radiological evaluation in order to define an accurate diagnosis.