Module 65, Pediatric Orthopaedist Level

This patient is a six year old male with a three week history of right foot pain. The mother and patient relate no history of trauma. Patient came home from school three weeks ago with pain and swelling over the medial aspect of the right foot. Symptoms have persisted for past three weeks. Mother states patient has been ambulating with a limp. There is tenderness to palpation and minimal swelling over the medial aspect of the right navicular.

Question 65A

After treatment in a short leg walking cast for six weeks, the foot pain had subsided so the child is allowed to return to normal activity.

Question 65B

After 3 months, the child returns because of repeat pain. You inform the mother that this is very unlikely and further work up is needed.

Question 65C

An x-ray at six months showed a very thinned navicular with irregular ossification. The mother is told that this is normal and in the long term there will be no disability from this process.

Question 65D

This condition is commonly associated with an accessory navicular which may become symptomatic.

Question 65E

Although these feet become asymptomatic over time, degenerative changes develop in the talonavicular joint.