Köhler Bone Disease
(Köhler's Bone Disease)
Köhler bone disease is osteochondrosis of the tarsal navicular bone.
Osteochondroses are noninflammatory, noninfectious derangements of bony growth at various ossification centers.
Köhler bone disease usually affects children aged 3 to 5 yr (more commonly boys) and is unilateral. The foot becomes swollen and painful; tenderness is maximal over the medial longitudinal arch. Weight bearing and walking increase discomfort, and gait is disturbed.
On x-ray, the navicular bone is initially flattened and sclerotic and later becomes fragmented, before reossification. X-rays comparing the affected side with the unaffected side help assess progression.
The course is chronic, but the disease rarely persists ≥ 2 yr. Rest, pain relief, and avoiding excessive weight bearing are required. The condition usually resolves spontaneously with no long-term sequelae. In acute cases, a few weeks of wearing a below-knee walking plaster cast, well molded under the longitudinal arch, may help.