The patient below has avascular necrosis of the navicular bone (also known as Mueller-Weiss syndrome). Surgical management should consist of arthrodesis of the talonavicular and the naviculocuneiform joints.
Spontaneous osteonecrosis of the navicular is a rare disease with many considering it related to Kohler’s disease. It is often seen in middle-aged patients in the fourth to fifth decade of life (in contrast to Kohler’s which is seen in the pediatric population) who present with chronic midfoot pain. The pain is generated by abnormal motion at the talonavicular and naviculocunieform joints. This diagnosis must be differentiated from a navicular stress fracture which also can present with chronic midfoot pain. The radiographs of navicular osteonecrosis show a narrow navicular bone with lateral sclerosis. There can also be a splitting of the navicular known as the “double navicular sign.” Initial treatment consists of semirigid insoles with surgical management consisting of talonavicular and naviculocuneiform fusion being reserved for patients who fail conservative management.