Köhler disease




Köhler disease and referred as Kohler disease.



Rare bone disorder of the foot found in children between six and nine years of age. 



Aseptic necrosis of the tarsal bone.



It a types of osteochondroses disease, which disturb bone growth at ossification centers which occurs during bone development.



The disease typically affects boys, but it can also affect girls. 



X-rays, show irregularity in growth and development of the tarsal/navicular bone in the foot. 



Köhler disease is known to affect five times more boys than girls.



Typically, only one foot is affected. 



Treatment for  Köhler disease include: 


Below knee cast, rest, NSAIDs, analgesics.



Prognosis is  good, with very few complications if treated



It is caused when the navicular bone temporarily loses its blood supply and 


tissue in the bone dies and the bone collapses. 



The process rarely can return in adults. 



As the navicular bone gets back to normal, symptoms typically abate.



Patients experience pain and swelling in the middle part of the foot and usually limp as a result. 



Patients who walk with a limp tend to walk with increased weight on the lateral side of the foot. 



There can be tenderness over the navicular. 



An X-ray of both feet is used to diagnose disease. 



The affected foot tends to have a sclerotic and flattened navicular bone. 



Symptoms may last for a few weeks or may continue to be present for up to 2 years.



Resolution of the acute inflammation and obvious healing of the foot means that the affected bone and the Tarsal Navicular begin to regain their normal size, density and structure.



Cause unknown.



Possible causes:  strain on the foot and the blood vessels associated with it, before the bone is able to ossify.



Bone ossification usually begins within the first 18 to 24 months of a female’s life and the first 24 to 30 months of a male’s life. 



Ossification occurs more slowly on the tarsal navicular bone than on other bones of the foot. 



Slow ossification causes an overall loss of blood supply.



Diagnosis is made on the basis of history and a high index of suspicion. 



There is tenderness to palpation on navicular head. 



Radiographs reveal typical changes of increased density and narrowing of the navicular bone.



Treatment: resting the affected foot, avoid putting pressure on the foot,and 





In acute cases, a cast usually worn for 6 to 8 weeks has efficacy



Prognosis for children with this disease is very good, as 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.







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