Kohler’s disease is an osteochondrosis of the navicular bone in the foot of children. The navicular bone is the bone that is at the top of the arch of the foot so in engineering terms it is subjected to a lot of force during weight bearing. For some reason the loads on the navicular bone cause a ‘softening’ of the bone and give the classic appearance on x-ray of being much more narrower than normal. Kohler’s Disease most commonly affects boys more than girls with a peak age of onset around 5 years of age. The child can be limping and often complains of vague pains over the top of the arch of the foot and the navicular bone is tender on palpation.
The treatment of this is usually protected weightbearing or limited weightbearing to allow the bone to recover. This can be a challenge as all children want to be active – moon boots and leg casts may be needed to enforce a restriction of activity. Foot orthotics are also helpful to protect the integrity of the arch of the foot. The long term prognosis is usually good and most recover without any long term issues.
