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.
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.
Treatment usually involves resting the affected foot, taking pain relievers and trying to avoid putting pressure on the foot. In acute cases, the patient is often fitted with a cast or cam walker that stops below the knee. The cast/cam walker is usually worn for 6 to 8 weeks. After the cast is taken off, some patients are prescribed arch support for about 6 months. Also, moderate exercise is often beneficial, and physical therapy may help as well.
Prognosis for children with this disease is very good. It may persist for some time, but most cases are resolved within two years of the initial diagnosis. Although in most cases no permanent damage is done, some will have lasting damage to the foot.
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 and thorough diagnosis is done.
Podiatrists at TFAAC have vast experience in diagnosing and treating Kohler’s Disease and typically this treatment is very successful but involves a multifactorial approach.