Kohler’s disease in children

What is Kohler’s disease?

Kohler’s disease (juvenile osteochondrosis of the navicular bone) is when the navicular bone tissue breaks down due to a lack of blood supply. The bone — a boat-shaped bone in the foot — is first visible on X-ray between 18 months and 2 years as a speck and looks like a small version of its adult shape by around age 4.
Without a blood supply, the bone becomes weak and collapses, causing pain. It is seen most often in elementary-school-age boys. It can start even younger, particularly in girls, whose bones mature faster than boys.

How is it diagnosed?

Most of the time, Kohler’s disease patients first show a painful limp, sometimes with some swelling in the arch area of the foot. Your child may offset the pain by walking on the outer border of the foot, especially when tired. Running and jumping are more painful.
An X-ray and physical exam can find Kohler’s disease. MRI or other advanced imaging is not needed to diagnose the issue.

Treatments

Standard treatment is a boot or short leg cast for four to six weeks. After cast removal, arch supports can help the transition back to regular shoes. Supportive shoes and ibuprofen often can help the pain.
Well-fitting athletic shoes should be worn, rather than flip-flops, for the first several weeks after cast removal. Symptoms may reappear if your child returns to jumping or high-impact sports soon after cast removal. Most patients have relief of symptoms three months after casting begins. Sometimes, symptoms persist for up to 15 months. If pain continues for this amount of time, more tests may be ordered.

After care

Kids generally can expect a full recovery without any issues in later childhood or as an adult. Some children may need more treatment, but surgery is rarely needed for this condition.

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