Köhler disease

Köhler disease
Synonyms	Aseptic necrosis of the tarsal bone, Kohler's Disease of the Tarsal Navicular, Osteochondritis of tarsal/metatarsal bone
Pronounce
Field	Orthopedics
Symptoms
Complications
Onset	6-9 years old
Duration
Types
Causes
Risks
Diagnosis
Differential diagnosis
Prevention
Treatment	Below knee cast, rest, NSAIDs, analgesics
Medication
Prognosis	Good, with very few complications if treated
Frequency
Deaths

Other names

Kohler's Disease; Kohler's Disease of the Tarsal Navicular; Kohler's Osteochondrosis of the Tarsal Navicular;

Clinical features

Kohler disease is a condition that affects a bone at the arch of the foot called the tarsal navicular bone. X-rays show that this bone is initially compressed and later breaks into pieces before healing and hardening back into bone. It occurs most frequently in children between the ages of 5 and 10 years.

Signs and symptoms

Signs and symptoms of the condition include swelling, redness and/or tenderness of the affected foot which can lead to a limp or abnormal gait (style of walking). Although the exact underlying cause of Kohler disease is unknown, some scientists suspect that it may be caused by excessive strain on the tarsal navicular bone and its associated blood vessels before the bone is completely ossified (hardened). The condition typically resolves on its own with or without treatment; however, pain relievers, rest, avoidance of weight-bearing activities, and/or casting may be recommended to help manage symptoms.

Symptoms

• The signs and symptoms of Kohler disease vary, but may include:
• Swelling of the foot
• Redness of the affected area
• Tenderness, particularly along the length of the arch
• Limp or abnormal gait (style of walking)
• Symptoms may worsen if weight is put on the affected foot, which can make walking painful and difficult.

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Cause

The exact underlying cause of Kohler disease is unknown. However, some scientists suspect that it may be caused by excessive strain on a certain bone of the foot (tarsal navicular bone) and its associated blood vessels before the bone is completely ossified (hardened).

Bone ossification usually begins at age 18-24 months in girls and at age 24 to 30 months in boys. As the child grows, their foot is required to support more weight. Ossification of the tarsal navicular bone often occurs more slowly than the other bones of the foot. Consequently, surrounding bones may compress it and its blood vessels resulting in osteonecrosis and ischemia (a loss of blood supply).

Inheritance

The exact underlying cause of Kohler disease is currently unknown. Although some scientists have suggested that genetic factors may play a role in the development of Kohler disease, no disease-causing gene has been identified.

Diagnosis

A diagnosis of Kohler disease is suspected based on the presence of characteristic signs and symptoms. An x-ray of the foot can be used to confirm the diagnosis and evaluate the progression of the condition.

Treatment

Kohler disease typically resolves over time with or without treatment. However, pain relievers, rest and avoidance of weight-bearing activities can help alleviate some of the symptoms. In some cases, a plaster walking cast and/or arch supports may also be recommended.

Prognosis

The long-term outlook (prognosis) for people with Kohler disease is usually excellent. Symptoms can last from a few days to two years; however, most cases resolve within a year. People affected by the condition typically recover all function of the affected foot and have no lasting consequences.

NIH genetic and rare disease info

• NIH info on Köhler disease

Köhler disease is a rare disease.