Complete spontaneous avascular necrosis of the adult navicula associated with Mee's growth arrest lines of the great and second toenails

Foot Ankle Surg. 2014 Mar;20(1):e7-e10. doi: 10.1016/j.fas.2013.10.002. Epub 2013 Nov 13.


Spontaneous total avascular necrosis of the tarsal navicula has been well documented in children (Kohler's disease) but is uncommon in adults where partial necrosis is usually seen after trauma or in Müller-Weiss disease. A case of spontaneous complete navicular osteonecrosis in a 46 year old female is described; she had accompanying Mee's leuchonychial lines in the toenails of the great and second toes only; the lines resolved after 9 months. She has been treated with an excision of the navicula and interpositional iliac crest bone graft talo-cuneiform fusion with resolution of her pain. It is postulated that the combination of the Mee's lines and avascular necrosis of the navicula indicates an occlusion of the dorsalis pedis in a predisposed individual.

Keywords: Aseptic necrosis; Avascular necrosis; Ischaemic necrosis; Lines; Mee's; Nail growth arrest; Navicula; Osteonecrosis; Spontaneous necrosis; Tarsal scaphoid.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bone Transplantation
  • Female
  • Foot / blood supply*
  • Humans
  • Middle Aged
  • Nails / blood supply*
  • Nails / pathology
  • Osteonecrosis / diagnosis
  • Osteonecrosis / surgery*
  • Tarsal Bones / blood supply*
  • Tarsal Bones / pathology
  • Tarsal Bones / surgery*