Medical Imaging Analysis Report

I. Radiological Findings

This patient is a 5-year-old male presenting with spontaneous right foot pain for 1 week and limping for 2 days. Based on the provided anteroposterior and lateral X-ray images of the foot, the following findings were noted:

• The contours of the talus, calcaneus, and surrounding tarsal bones appear essentially normal, without evident destructive lesions.
• The navicular bone shows an irregular shape, with mild flattening in the anteroposterior dimension and focal sclerosis.
• No obvious narrowing or destruction is noted in the adjacent joint spaces; the surrounding metatarsals, cuneiforms, and other bone signals appear relatively normal.
• No significant soft tissue swelling or foreign body is observed.

These findings suggest a possible epiphyseal developmental abnormality or ischemic change in the navicular bone. Considering the patient’s age and symptoms, there is a high suspicion of osteochondropathy (e.g., Kohler disease) of the navicular.

II. Differential Diagnosis

1. Kohler Disease (Navicular Osteochondrosis)
   Typically occurring in children between 4 and 6 years of age, especially in boys. The main features include localized pain in the navicular area and limping. On X-rays, the navicular appears flattened and sclerotic without involvement of adjacent joints.
2. Tarsal Coalition
   Abnormal fusion of the navicular or other tarsal bones can lead to restricted movement of small foot joints, causing foot pain and limping. However, imaging often suggests bony or fibrous fusion, which does not fully match the isolated navicular sclerosis and flattening seen in this case.
3. Normal Variation with Multiple Ossification Centers of the Navicular
   Occasionally, the navicular may have multiple ossification centers and appear irregular on X-ray. If there are no or only mild symptoms, one must rule out benign variations. However, given the patient’s pain, limping, and notable flattening and sclerosis on X-ray, a pathological process is more likely.
4. Infection or Other Bone Lesions (Rare)
   Bone infection (osteomyelitis) typically presents with significant inflammatory response and destructive changes on imaging, such as cortical disruption or bone destruction, which are not seen here. Nonetheless, it should be considered clinically in suspicious cases.

III. Final Diagnosis

Considering the patient’s age, clinical presentation (foot pain, limping), and the X-ray findings of a flattened, sclerotic navicular without obvious abnormalities in surrounding joints, the most likely diagnosis is:

Kohler Disease (Navicular Osteochondrosis).

This disease is generally self-limiting. As the child grows, the affected bone’s shape and density can gradually return to normal. If symptoms persist or the course is unusually prolonged, other related conditions should be ruled out.

IV. Treatment Plan and Rehabilitation

1. Treatment Options:

• Conservative Treatment: Most children with Kohler disease improve with a “rest–offloading–observation” approach. Possible measures include:
  • Reduce high-intensity or impact activities; avoid prolonged walking or running.
  • Use padded footwear or orthotic insoles to relieve pain and decrease plantar pressure.
  • If symptoms are severe, consider casting or bracing, typically for 4–8 weeks.
• Medication: Usually no specific medication is required. Short-term use of NSAIDs can help if pain is significant.
• Surgical Intervention: Rarely needed, typically considered only if there are other complications (e.g., tarsal coalition, structural deformities) or an atypical clinical course.

2. Rehabilitation/Exercise Prescription (FITT-VP Principle):

• Frequency: 2–3 times per week or as advised by a physician. During periods of intense pain, complete rest may be necessary initially.
• Intensity: Keep activity pain-free or with minimal discomfort. Avoid running, jumping, or other high-impact exercises. Low-impact activities (such as swimming or using a stationary bike) can be introduced gradually.
• Time: Start with 10–20 minutes per session, increasing slowly based on the degree of symptom relief.
• Type: Early stages should emphasize low-stress, aerobic exercises such as swimming or cycling to reduce weight-bearing stress on the foot. Gradually progress to short-distance walking or light jogging.
• Progression: Increase exercise duration and intensity over 2–4 weeks only if pain is well-controlled. Reduce intensity and revisit clinical evaluation if pain worsens or new discomfort occurs.
• Additional Notes (Volume, Pattern): Because the child’s bones are still developing, avoid excessive loading or high-intensity training. It may be beneficial to split training into multiple shorter sessions to reduce the load each time.

V. Disclaimer

This report is a reference analysis based on existing examinations and clinical information. It is not a substitute for in-person consultation or a professional physician’s diagnostic and treatment advice. If there are any concerns or worsening symptoms, please seek medical attention promptly for further evaluation and targeted management.