Kohler Disease

Overview

Kohler disease is a rare paediatric condition characterized by avascular necrosis of the navicular bone in the foot. This condition leads to inflammation and subsequent collapse of the bone due to a temporary loss of blood supply. Kohler disease typically affects children between the ages of 2 and 9 years and is often self-limiting, meaning it tends to resolve on its own with appropriate management. Understanding Kohler disease is essential for early diagnosis and effective treatment.

Introduction

First described by Austrian surgeon Alban Köhler in 1908, Kohler disease primarily affects the tarsal navicular bone, which plays a crucial role in the structure and function of the foot. The condition can result in significant pain and difficulty in walking, impacting a child’s mobility and quality of life. In India, where children are often active in sports and physical activities, awareness of Kohler disease is vital for timely intervention.

Symptoms

The symptoms of Kohler disease can vary in severity but typically include:

– Foot Pain: Persistent pain localized to the midfoot, particularly over the navicular bone.
– Swelling: Noticeable swelling around the affected area.
– Tenderness: Increased sensitivity when pressure is applied to the midfoot.
– Limping: Children may exhibit a limp or favour one foot while walking due to pain.
– Difficulty Bearing Weight: Pain may cause reluctance to walk or stand for extended periods.
– Warmth and Redness: The area may feel warm to the touch, indicating inflammation.

Symptoms can develop gradually and may worsen with physical activity.

Causes

The exact cause of Kohler disease remains unclear; however, several factors are believed to contribute:

– Avascular Necrosis: The primary mechanism involves a temporary loss of blood supply to the navicular bone, leading to bone tissue death.
– Repetitive Stress: Activities that involve repetitive loading or trauma to the foot can increase the risk of developing this condition.
– Genetic Factors: Some studies suggest a genetic predisposition may play a role in the development of Kohler disease.
– Inadequate Ossification: The navicular bone may be more susceptible due to its slower rate of ossification compared to other bones.

Treatment

Treatment for Kohler disease focuses on relieving symptoms and promoting healing:

– Rest: Limiting weight-bearing activities is crucial for recovery.
– Immobilization: A walking boot or cast may be used to immobilize the foot and reduce stress on the navicular bone.
– Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and reduce inflammation.
– Physical Therapy: Once symptoms improve, rehabilitation exercises can help restore strength and mobility.

Most cases resolve within several months without long-term complications.

Prevention and Risk Factors

Preventive measures for Kohler disease are limited due to its unclear etiology; however, certain strategies may help minimize risk:

– Avoiding Excessive Stress: Limiting high-impact activities in young children may reduce strain on developing bones.
– Monitoring Foot Health: Regular check-ups with a paediatrician can help identify potential issues early.

Risk factors for developing Kohler disease include:

– Age: Most commonly affects children aged 2 to 9 years.
– Gender: More prevalent in boys than girls.
– Previous Foot Injuries: A history of trauma may increase susceptibility.

Insights from Sancheti Hospital

At Sancheti Hospital, we understand that Kohler disease can significantly impact your child’s quality of life. Our team of experienced paediatric orthopedic specialists employs advanced diagnostic techniques to accurately assess your child’s condition. We offer a comprehensive range of treatment options tailored to individual needs, ensuring optimal recovery. Our focus on patient education empowers families with knowledge about their child’s condition while promoting proactive management strategies for better outcomes. By addressing both immediate symptoms and long-term health goals, we strive to enhance our patients’ quality of life through compassionate care.