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Köhler Bone Disease

(Köhler's Bone Disease)

By

Frank Pessler

, MD, PhD, Helmholtz Centre for Infection Research

Reviewed/Revised Nov 2022
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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 caused by a poor blood supply to the tarsal navicular bone. The poor blood supply causes the tarsal navicular bone to die and collapse. Why the blood supply is poor is not known.

Köhler bone disease usually affects children aged 3 to 5 years (more commonly boys) and typically 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.

Bones of the Foot

Bones of the Foot

Diagnosis of Köhler Bone Disease

  • X-rays

X-rays X-Rays X-rays are a type of medical imaging that use very low-dose radiation waves to take pictures of bones and soft tissues. X-rays may be used alone (conventional x-ray imaging) or combined with... read more of the foot 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.

Treatment of Köhler Bone Disease

  • Rest and pain relievers

  • Sometimes a cast

Köhler bone disease rarely lasts more than 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 Immobilization for a few weeks may help. Crutches are often not needed with a walking cast.

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