Treating Avascular Necrosis of the Navicular in Pediatric and Adult Patients

Q: What are your pearls for treating AVN of the navicular in pediatric patients?

A: One should place pediatric patients in a short leg cast on initial presentation, advises Marc Jones, DPM. He notes this will heal patients faster, saying placing patients in orthotics or merely modifying their activities will eventually heal AVN, but will take much longer.

Q: What are your pearls for treating AVN of the navicular in adult patients?

A: “The earlier that you catch and treat the AVN the high chance of success the patient has for a better outcome,” says Dr. Jones. 
 
Dr. Jones notes surgery is based on symptoms rather than the severity of the deformity—treat the patient not the radiograph. Also, when fusion/reconstructing the medial column, he says the goal should be to restore Meary's angle.

Q: What particular challenges have you faced in treating this in either population?

A: Dr. Jones cites a high rate of nonunion in these patients where fusing one joint or multiple joints. Dead bone will not fuse, grafts are necessary, and the patient's own illiac bone crest should be the first choice of grafts. He says one should counsel the patient prior to the surgery regarding the high rate of failure.

Q: What are the most important points attendees should take away from your session?

A: Pediatric AVN is treated conservatively and adult AVN nearly always needs surgical treatment, generally with arthrodesis, says Dr. Jones. He notes treating adult AVN of the navicular is challenging but can be successful.