Kohler Disease (Arch Pain)

Diagnosing the cause of the Arch Pain and how we can treat it.

Kohler Disease is a rare benign bone disorder, found in children between 4 and 9 years of age, which causes arch pain and discomfort.

This condition is caused from avascular necrosis (loss of blood supply) to the navicular bone, which is located in the midfoot and is usually self-limiting.

Due to the loss of blood supply, parts of the navicular bone can die, fragment or collapse, before healing and hardening. This condition is more prominent in boys but it can also affect girls.

Causes of Kohler Disease (Arch Pain):

  • Loss of blood supply to navicular bone, which may be affected by weight bearing pressures and stresses caused by running, hoping, jumping, skipping.

Diagnosis of Kohler Disease (Arch Pain):

  • X-ray, where the navicular bone will present with patchy sclerosis (thinned) and is often associated with soft tissue swelling.
  • CT and MRI, this is not usually necessary but may be used if pain persists and the X-ray diagnosis is not clear.
  • Physical examination.

Symptoms of Kohler Disease (Arch Pain):

  • Mild limping or walking on outside of foot to relieve pain.
  • Swelling, redness, warmth, tenderness in localised area of foot, which can range from a few days or be persistent for up to two years.
  • Palpable pain over the navicular bone.
  • Usually involves just one foot.

Treatment for Kohler Disease (Arch Pain):

  •  Rest and avoidance of excessive weight-bearing.
  •  Anti-inflammatory medications.
  • Most resolve with age and the affected navicular will regain its size, density and structure within a year or two as the area re-ossifies.
  • Children may require immobilisation in a removable boot to offload the area for 6-8 weeks.
  • Foot orthoses to support the midfoot and arch of the feet.
  • Serial plaster casting is occasionally used for severe prolonged symptoms.
  • Surgery is not recommended in this condition.

Well Heeled Podiatry is experienced in dealing with arch pain and familiar with this type of condition. A thorough assessment of your child’s arch pain will be undertaken to make a diagnosis and choose a treatment regime to relieve your child’s symptoms.

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