Kohler's

KOHLER’S
By:  Robert H. Sheinberg, D.P.M., D.A.B.F.A.S., F.A.C.F.A.S. 

Kohler’s is a condition of the navicular bone in the top inside of the foot.  It is a relatively infrequent condition that affects children most commonly between the ages of 3 and 7 years old as this bone is starting to develop.

CAUSES: 

  • A temporary interruption of the blood supply to the bone.
  • May be caused by minor or major trauma to the midfoot region.

SYMPTOMS:

  • Pain and tenderness is present across the top and inside of the foot.  The bone sits just in front of the ankle on the inner portion of the foot almost at the highest peak of the arch.
  • Swelling if present is usually to a very low degree.  No discoloration is seen.
  • The child is often limping and trying to avoid that area of the foot.  The child will often walk on the ball of the foot although frequently on the outside of the foot and ankle, preventing the heel and inside of the foot from moving towards the ground.
  • When the child moves the foot down and in, pain is often present to the inside of the foot towards the ankle.

X-RAYS:

  •  X-rays reveal whitening and thinning of the bone.  The bone will appear to be denser than the bones around them.

The following x-ray images depict the atrophic disease of the navicular bone in the middle of the foot viewed as a thin line of bone in the lateral view (top left), oblique view (top right) and dorsal-plantar view (bottom left).

TREATMENT:

  • During the acute phase of this injury the child is best placed in a cast below the knee with the use of crutches.  This will allow the area to rest and heal without any long-term problems. 
  • A boot should then be applied once the child is able to put weight on the cast for a week. 
  • This is followed by an orthotic to be placed in the shoe to continue to support the area and prevent the foot from breaking down.
  •  Long-term prognosis is excellent.