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Köhler Bone Disease

by David D. Sherry, MD, Frank Pessler, MD, PhD

Köhler bone disease is osteochondrosis of the tarsal navicular bone.

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.

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