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.