The arch of the foot is a very important shape thats strength is needed for normal biomechanics of the foot. As with any engineering structure just like an arch, the component which is at the top of the arch has a whole lot of forces. In the feet, the element that is towards the top of the arch will be the navicular bone. This means that while we are bearing weight that navicular bone is going to be subject to a large amount of forces. In healthy situations that navicular bone is made and built to carry that load and can accommodate elevated stress if given time. Even so, sometimes things could go wrong, and the navicular breaks down. In an athlete that can be something similar to a stress fracture of the navicular bone. An actual problem of the navicular bone that happens in children is a condition called Kohlers Disease. This condition more frequently impacts boys than girls and has an affect on kids between the ages of 3 to 9 with approximately age 5 to be the most typical age. For some reason the bone is on holiday ‘softened’ and becomes squeezed by weightbearing loads coming from the navicular staying in the peak of the arch.
Generally, only one foot is impacted, and it is very unusual to have both feet affected simultaneously. There's a obscure pain around the top of the foot in the midfoot region and a pain can be localised over the navicular on poking. It's very frequent for the child to limp due to the pain plus they can avoid trying to tilt the foot inwards as that could be painful. Characteristically and typically on x-ray there is a characteristic thinning of navicular with the abnormal development of the density overall look of the navicular. This can be apparent and very distinct. During the early acute phases of Kohler’s Disease, you have to get weight off the foot. They should cease all sport and running around in school in the short term as the stress over the navicular must be reduced to a minimum. Things like a moon boot could be used to help restrict exercise. Occasionally crutches may be needed for getting all bodyweight off of the foot. Should the initial signs and symptoms aren't bad or things have calmed down through that intense phase, restricted weightbearing may be used and foot supports are very important to support the arch of the foot and reduce loads on the navicular bone allowing a higher level of exercise over time. If the issue is more serious, then a lower limb cast is frequently required to safeguard the foot. The structural posture of the arch truly does need to be protected by using foot supports to avoid a reoccurrence of the Kohlers Disease or the development of any sort of deformity from damage to the navicular whilst the disorder was active. The long-term prognosis of the majority of occurrences is usually pretty good and most haven't any long-term complications. Those who did have Kohler’s disease when they were young do need to take heed to any arch problems developing over time.