Köhler bone disease is death (necrosis) of the tarsal navicular bone (a bone at the arch of the foot) due to loss of its blood supply.
Köhler bone disease is an osteochondrosis. An osteochondrosis is a disorder of the growth plate of bones that occurs when a child is growing rapidly.
Köhler bone disease is rare. It usually affects children aged 3 to 5 years (more commonly boys) and typically affects only one foot.
This disease is caused by a poor blood supply to the tarsal navicular bone. The poor blood supply causes the bone to die and collapse. Why the blood supply is poor is not known.
In Köhler bone disease, the foot becomes swollen and painful, and the arch of the foot is tender. Putting weight on the foot and walking increase discomfort, and the child’s manner of walking (gait) is impaired.
Bones of the Foot
Diagnosis of Köhler Bone Disease
X-rays
X-rays of the foot show that the navicular bone is initially flattened and hardened. Later x-rays show the bone is broken into fragments before it heals and hardens back into bone.
X-rays comparing the affected side with the unaffected side help doctors assess how far the disease has progressed.
Treatment of Köhler Bone Disease
Rest and pain relievers
Sometimes a cast
Children should rest and receive pain relievers (such as ibuprofen). They should stay off the foot as much as possible.Children should rest and receive pain relievers (such as ibuprofen). They should stay off the foot as much as possible.
A plaster walking cast worn for a few weeks may help some children. This cast reduces weight bearing and keeps the foot immobile, thereby reducing pain. The cast begins just below the knee and extends to the base of the toes, including the foot and ankle. Crutches are often not needed with a walking cast.
Köhler bone disease rarely lasts more than 2 years. It usually resolves on its own and does not cause any long-term consequences.
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