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Discovering the A to Z of Kohler's Disease

Globally, Kohler's disease affects 2-3% of children aged 3-10 years. 

Human anatomy dictates the standard of life, with our feet an intricate component of it. It supports us to become independent and navigate our way to success. But unfortunately, for many children, the ride is not as joyful as others. That is because of an unforeseen hurdle they face in the unripe years of their lives - Kohler’s disease. A foot anomaly that shakes the balance of their existence and puts a hold on their smile.

Luckily, there is a silver lining to Kohler’s disease. Despite the mystery around it, the condition is known to have an excellent prognosis. But as parents, you must be aware of the issue to give your child the best possible care for a speedy recovery. 

So, here’s a comprehensive guide to help you help your little one overcome the challenge like a champ.

What is Kohler’s disease?

Described in 1908 by Alban Kohler, after whom it is named, Kohler’s disease is a childhood foot disorder. It causes avascular necrosis on the navicular bone (wedge-shaped bone in the midfoot). This means that there is a loss of blood flow to the bone. Although mostly temporary, the situation leads to the death of the tissue in the bone. And ultimately the inevitable - bone collapse. 

Kohler’s disease affects children in their developmental years, with 3 to 7 being the peak time. It is also five times more prevalent in males than in females. But, it is very rare with the incidence believed to be less than 2%. The condition is characterized by swelling or outgrowth, typically on one foot. Although, the issue may be bilateral in about 25% of cases. 

The key highlight is that kids seem to grow out of it. To be specific, the affected bones may regain their shape, size, and density within a few weeks or months. Both with and without treatment. That being said, every case is different, and in some instances, the pain may even last for several years. So, it is best not to leave things totally up to chance. 

Kohler’s disease symptoms

A painful swollen foot is the most prominent symptom of Kohler’s disease. Coupled with some related discomforts like:

  • Excessive tenderness along the arch length

  • Redness in the affected spot

  • Difficulty in moving the foot (stiffness)

  • Limping or gait to avoid putting pressure on the painful area

  • Weight gain in the affected foot

What causes Kohler’s bone disease?

The exact reason behind the development of this foot disorder is unknown. However, specialists have listed some of Kohler’s disease causes that may trigger the problem. 

  1. Injury or abnormal strain in the area surrounding the navicular bone of the foot

  2. Delayed bone formation

Note: Aka ossification, proper bone formation is crucial to avert Kohler’s disease. It usually happens between months 18–24 and 24–30 in girls and boys, respectively. But, when the process is delayed, the cartilage-to-bone ratio increases. This causes structural weakness. The bone is subjected to weight-bearing compression. And it suffers from repeated twists and turns. 

Also, under usual situations, there is an increased blood supply in the bone growth areas. Mostly at the time when the child is around 4–6 years old. But if there is a delayed ossification and weight gain in them, the blood vessels get compressed. This results in the destruction of tissues known as ischemia. 

Is Kohler’s disease hereditary?

Well, yes, besides the above factors, genes can play a part in whether the child will have the disorder or not. But as of the present day, no such particular gene has been identified to be the main culprit. 

Kohler’s disease and similar disorders

It is important to note that Kohler’s disease symptoms may match those of some other disorders. So, to ensure a proper diagnosis, differentiating the diseases is essential.

  1. Freiberg Disease - Just like Kohler’s disease, Freiberg is also an uncommon bone disorder. It is marked by pain but in this case, the discomfort occurs in the second or third metatarsals. In other words, in the long bones of the foot. Walking difficulties, limping and weight gain in the affected foot are some symptoms it shares with Kohler’s disease. The issue mostly is diagnosed in the adolescent phase or the 20s. 

  2. Grierson-Gopalan syndrome - This condition leads to a burning feeling in the feet. You can also get severe cramps, pains, and a sensation similar to needles and pins. The problem is believed to be a result of Vitamin B deficiency. 

Kohler’s disease diagnosis

The presence of Kohler’s disease symptoms is the most obvious way to suspect the condition. Following that, the clinical diagnosis is usually done with an X-ray. Kohler’s disease x-ray reports will show the navicular bone flattened and fragmented. This will, in most cases, be a contrast to the structure of the bone in the unaffected foot. Thereby confirming Kohler’s disease diagnosis. 

Note: This comparison theory won’t work for bilateral patients. Doctors usually delve into the finer details in these situations.

Kohler’s disease treatment

Kohler’s disease foot complication, being self-limiting, does get cured on its own. But it may last for a few days, months, or even 2 years. So, if the discomfort hinders daily living greatly, it is better not to wait too long for therapy. 

Your physician may recommend the following Kohler’s disease treatment:

  • Pain relievers

  • Short leg weight-bearing plaster casts

  • Specialized supportive footwear

  • Getting enough rest to avoid putting stress on the affected foot

Physical therapy for Kohler’s disease

The treatment of the disorder can also include physiotherapy. This often promises a faster road to recovery. Kohler’s disease physical therapy will focus on restoring the freedom of movement to your child by:

  • Eliminating the stiffness in the foot

  • Improving the strength of the muscles

  • Restoring balance

  • Increasing mobility

To ensure the above, this Kohler’s disease treatment may include:

  1. Stretching exercises

  2. Teaching the child to mobilize without support

  3. Hydrotherapy (relaxes and strengthens stiff muscles)

  4. Performing functioning movements like moving up and down stairs

Please note that such rehabilitation programs do not have to be generalized. You can talk to the physiotherapist about a customized treatment to suit the needs of your child. 

Closing Thoughts

Kohler’s disease is a rare foot ailment. It also does not have any major long-term impacts in the future. Meaning that a full recovery is definitely on the cards. But despite being transient, the impact it has on a child’s formative years is enough to take it seriously. So, if your little one complains of foot pain or shows similar signs, consult a doctor and get started with the cure.


The Author : Dr. Sunil Khattri 

+91 9811618704

Dr. Sunil Khattri MBBS, MS(General Surgery), LLB, is a Medical doctor and is a practicing Advocate in the Supreme Court of India and National Consumer Disputes Redressal Commission, New Delhi.

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