Common Disorders
Kohler's Disease
Kohler's Disease is a spontaneous loss of blood supply to a bone in the foot called the Navicular bone. Dr. Kohler described it in 1908. The spontaneous loss of blood supply to a bone is called osteochondrosis. In later years Dr. Kohler was also associated with another osteochondrosis of the foot known as Freiberg's disease. Some texts refer to this condition as Kohler's II.
Clinical features and Treatment
Clinically, the presentation of Kohler's disease may be an incidental x-ray finding. Often, however, localized pain or a painful gait is noted. Occasionally mild swelling is seen. It is seen most commonly in males and most cases only affect one foot. Biopsy of the bone to make the diagnosis is not necessary.
Complete recovery is almost always the rule; therefore, treatment efforts should be conservative. Cast immobilization provides satisfactory results. Reduced activities and foot orthotics (inserts for the shoes) have also proved effective. Most cases respond within 8 months. Follow-up studies after 30 years have shown no residual degenerative changes in spite of severe fragmentation and flattening of the navicular bone. It is interesting to note that Kohler's disease has been reported to be associated with "Tarsal Coalition" in this area. So it is important that proper follow-up be done.
This article was adapted from the text book Foot and Ankle Disorders in Children edited by Dr. Steven DeValentine.
