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Diseases

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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Overview



What is Kohler disease?

What are the signs and symptoms of Kohler disease?

What causes Kohler disease?

How might Kohler disease be treated?


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

References
  1. Köhler's Bone Disease. Merck Manuals. February 2008; http://www.merckmanuals.com/home/childrens_health_issues/bone_disorders_in_children/k%C3%B6hlers_bone_disease.html?qt=kohler&alt=sh#v821464. Accessed 7/20/2012.
  2. Osteochondroses. MERCK Manual. 2005; http://www.merck.com/mmpe/sec19/ch284/ch284j.html. Accessed 4/1/2009.
  3. Vargas B. Köhler Disease. eMedicine. 2009; http://emedicine.medscape.com/article/1234753-overview. Accessed 4/1/2009.
  4. Kohler disease. NORD. February 5, 2008; http://www.rarediseases.org/rare-disease-information/rare-diseases/byID/800/viewAbstract. Accessed 7/20/2012.