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Köhler Bone Disease

(Köhler's Bone Disease)

By David D. Sherry, MD, Professor of Pediatrics; Director, Clinical Rheumatology, University of Pennsylvania; The Children's Hospital of Philadelphia
Frank Pessler, MD, PhD, Helmholtz Centre for Infection Research; Hannover Medical School, Braunschweig, Germany; Hannover, Germany

Köhler bone disease is inflammation of the tarsal navicular bone (a bone at the arch of the foot).

Köhler bone disease usually affects children aged 3 to 5 years (more commonly boys) and affects only one foot. The foot becomes swollen and painful, and the arch of the foot is tender. Weight bearing and walking increase discomfort, and the child’s manner of walking (gait) is impaired. X-rays show that the navicular bone is initially flattened and hardened and later breaks into fragments before healing and hardening back into bone. X-rays comparing the affected side with the unaffected side help assess how far the disease has progressed.

Köhler bone disease rarely lasts beyond 2 years. Rest and pain relief are required, and excessive weight bearing must be avoided. This disease usually resolves without treatment and without any long-term consequences. In severe cases, having the child wear a below-knee walking plaster cast (well molded under the length of the arch of the foot) for a few weeks may help.