Kohler's disease
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11/1/2018 at 10:11:54 PM GMT
Posts: 2
Kohler's disease

Köhler disease (navicular osteochondrosis)

We have had a couple a couple kids present with foot pain and unusual foot x-rays to our Ortho Urgent Care over the last few months. These kids were diagnosed with Kohler Disease. I had no idea what this was until a couple of other PAs on our team did some quick research and spoke to two of our pediatric ortho surgeons. Here is the quick synapse.

·         Occurs in children younger than 10.

·         Usually idiopathic but may be prompted by remote trauma.

·         Patient presents with progressive midfoot pain with weight bearing.

·         More common in boys (80%).

·         Can be bilateral in 25% of the cases.

·         They have decrease blood flow to the central 1/3 of the navicular causing avn.

·         The navicular is the last bone in the foot to ossify.

·         Also puts them at increased risk of stress fx of navicular

·         Often misdiagnosed as an infection.

·         Xrays show sclerosis, fragmentation, and flattening of navicular

 

Prognosis: says most of the tarsal navicular bones reorganize after disease has ran its course usually 6-48 months.

Tx: NSAIDS, immobilize with boot or short leg walking cast. Modify activities. In follow-up may consider prescription arch support to offload pressure

Just another unusually pediatric condition that those of us who don’t specialize in pediatrics should keep on your radar.