For some, however, symptoms may last as long as two years. In this uncommon condition, kids present with a limp and local tenderness of the medial aspect of the foot over the navicular.
Kohler's disease is an uncommon bone disorder in which the navicular bone of the foot for the time being loses its blood supply (avascular necrosis). It is caused when the navicular bone temporarily loses its blood supply. As an effect, tissue in the bone dies and the bone collapses. The navicula is the last tarsal bone to harden in children. This bone might be compressed between the already ossified talus and the cuneiforms when the child becomes heavier. Compression involves the vessels in central spongy bone leading to ischemia. Thereafter, the perichondral ring of vessels sends the blood supply, allowing rapid revascularization and formation of new bone.
It is characterized by limping caused by pain and swelling in the foot. It most frequently occurs in children between the ages of three and seven and it influences males five times more frequently than it does females. Typically, just one foot is affected. Infant appear to grow out of the disorder, and the affected bones regain their size, density and structure within a year. The child can walk with an increased weight on the lateral side of the foot.
Swelling and redness of soft tissues are frequent. The disease typically affects boys, but it can also influence girls. Five is the age of boys most frequently affected and patients often complain of pain over the apex. This is probably due to the onset of ossification in girls, which occurs at age 18-24 months, whereas in boys, ossification occurs at age 24-30 months. If Kohler's Disease is suspected, x-rays of the foot should be obtained. The x-rays are usually abnormal and show damage to the navicular bone in the midfoot. The symptoms typically resolve spontaneously with minimal treatment.
The standard treatment is to place the child in a short-leg walking cast for several weeks to allow the symptoms to subside. Modest exercise is frequently beneficial. An UCB arch support if the pain is less so. Non-steroidal anti-inflammatory medications may help. The child may have to rest from sports for a few weeks till the acute pain is relieved. A weight-bearing, below-the-knee cast is recommended. Total cast time is approximately 6-8 weeks. The cast is better in moderate virus (10-15º) that is associated with moderate equinus (10-20º). In mild cases, soft arch supports may be the only treatment needed.
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