Köhler’s disease in children — navicular bone pain.
A limping 4-7 year old with midfoot pain, swelling and tenderness over the top of the foot. Köhler’s disease is an uncommon condition affecting the navicular bone — usually self-limiting but worth getting properly diagnosed and managed.
What Köhler’s disease is.
Köhler’s disease is an avascular necrosis (temporary loss of blood supply) of the navicular bone in the midfoot. The exact cause isn’t fully understood — thought to relate to the navicular being the last tarsal bone to ossify in children, leaving it vulnerable to vascular compromise during growth.
It typically affects children aged 4-7 years, more commonly boys. Presentation: gradual onset of midfoot pain, sometimes after a minor injury, sometimes spontaneously. The child may limp, walk on the outside of the foot to avoid loading the navicular, or refuse to weight-bear in severe cases. Localised tenderness over the dorsal (top) aspect of the navicular is classic.
The reassuring part: Köhler’s is almost always self-limiting. The navicular re-vascularises and re-ossifies within months to a couple of years, with full restoration of normal foot structure and function. Management is about pain control and protecting the bone while it heals.
Six elements of Köhler’s management.
No active treatment changes the course of Köhler’s — the bone heals on its own timeline. The plan is about managing symptoms and protecting activity.
Three steps from first visit to outcome.
