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Genetic and Rare Diseases Information Center (GARD)

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Kohler disease

Other Names for this Disease
  • Kohler's Disease
  • Kohler's Disease of the Tarsal Navicular
  • Kohler's Osteochondrosis of the Tarsal Navicular
  • Navicular Osteochondrosis
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Your Question

What is Kohler disease? Also what's the difference between "osteochondrosis" and "osteonecrosis?"

Our Answer

We have identified the following information that we hope you find helpful. If you still have questions, please contact us.

What is Kohler disease?

Kohler disease is a condition that involves a bone at the arch of the foot called the tarsal navicular bone. In this condition, the tarsal navicular bone breaks into fragments before healing and hardening.[1] Signs and symptoms are usually mild and may include limping, swelling and pain in the affected foot.[2][1] The condition most often affects children aged 3 to 5 years and usually involves just one foot.[2][3] Although the underlying cause it not well understood, it is thought to be due to interruption of blood flow to the navicular bone, resulting in degeneration of the bone.[4] Treatment may involve rest and avoidance of excessive weight-bearing.[2][3]
Last updated: 7/20/2012

What are the signs and symptoms of Kohler disease?

The signs and symptoms of Kohler disease may include swelling, foot pain, and a limp or abnormal gait (way of walking). These symptoms may worsen with weight bearing.[2]
Last updated: 7/20/2012

What causes Kohler disease?

While the exact cause of Kohler disease is unknown, it is thought to be triggered by excessive strain on the tarsal navicular bone and its blood vessels before ossification (the hardening of bones).[3]

Bone ossification in girls tends to begin at age 18-24 months, and in boys at age 24 to 30 months. As the child grows, their foot is required to support more weight. If the navicular bone ossifies slower than the surrounding bones, the surrounding bones may compress it and its blood vessels resulting in osteonecrosis and ischemia (a loss of blood supply).  In response to this loss of blood supply the child’s body forces more blood to the tarsal navicular bone causing quick revascularization (formation of new blood vessels) and formation of new bone.[3]
Last updated: 7/20/2012

How might Kohler disease be treated?

Treatment of Kohler disease may involve rest, pain relief, and avoiding excessive weight bearing. In acute cases, a few weeks in a below-knee walking plaster cast, well molded under the arch of the foot, may help.[2] Special supportive shoes may also be considered. Symptoms can last for a few days or persist for up to two years; however, they usually resolve within a year.[4]
Last updated: 7/20/2012

What is the typical prognosis for patients with Kohler disease?

Children with this condtion tend to have an excellent prognosis. Kohler disease may persist for a while, but nearly always resolves within, at the latest, two years.[2]
Last updated: 4/27/2009

What is osteochondrosis?

Kohler disease is considered a type of osteochondrosis. Osteochondrosis is a disease in which an ossification center undergoes degeneration (breakdown) followed by calcification.[5] An ossification center is a point within a developing bone where bone formation (ossification) begins. Osteochondrosis most commonly affects the epiphyses of long bones in children.[5] Click here to view an illustration of epiphyses. 
Last updated: 4/27/2009

What is osteonecrosis?

Osteonecrosis is a medical term referring to the death of cells within bone caused by a lack of circulation. Osteonecrosis can occur in virtually any bone. In the foot it most commonly affects the talus, the first and second metatarsals, and the navicular bone. Osteonecrosis can cause both adult and pediatric foot pain. It is associated with many foot problems, including fractures of the talar neck and navicular as well as Kohler disease and Freiberg disease.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), part of the National Institutes of Health (NIH), offers printed materials on osteonecrosis which includes information on its symptoms, causes, and treatment. You can view this information at the link below.

More information on osteonecrosis can be found at the following link from MedlinePlus, the National Library of Medicine Web site designed to help you research your health questions.
Last updated: 4/27/2009