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

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.