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Köhler Bone Disease

(Köhler's Bone Disease)

By Frank Pessler, MD, PhD, Helmholtz Centre for Infection Research; Hannover Medical School, Braunschweig, Germany; Hannover, Germany

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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.