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September 10, 2025Open Access

Kohler Disease With Concurrent Avascular Necrosis of the Medial Cuneiform: A Report of Two Cases

KHKatie W HolleyEast Tennessee State University BPB A PriceWhiteley Clinic WMWilliam F McCormick

Key Points

Both patients showed resolution of symptoms and radiographic findings after conservative treatment.
Idiopathic avascular necrosis of the navicular, also known as Kohler disease, was diagnosed in both cases.
Conservative treatment included rest and limited weight-bearing for approximately 12 weeks.
This report reassures physicians of the effectiveness of conservative management for rare conditions.

Abstract

Two patients, ages five and eight, presented to a pediatric orthopedic surgeon with dorsomedial midfoot pain. After further evaluation, each was diagnosed with idiopathic avascular necrosis of the navicular, also known as Kohler disease, with concurrent avascular necrosis of the ipsilateral medial cuneiform. Both patients were treated conservatively with rest, immobilization, limited weight-bearing, and reduced activity, and both saw resolution of symptoms and radiographic findings by the completion of follow-up. This report aims to reassure physicians that, even with uncommon and unexpected radiographic findings, Kohler disease can be managed conservatively and can result in full recovery and return to activity as soon as 12 weeks after initiating treatment.

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