It typically presents in the paediatric population (4-6 years of age) and there is a recognised male predilection.
Although the aetiology remains unknown, a vascular incident is suspected. Delayed bone age has also been noted in some cases and may play a part in the pathogenesis of this entity.
- navicular may appear wafer-like (thinned) and fragmented
- demonstrates patchy sclerosis (similar to osteonecrosis elsewhere)
- often associated soft tissue swelling
Cross-sectional imaging is usually not required but may be necessary if pain persists or the diagnosis is not clear.
Treatment and prognosis
Köhler disease often tends to be self-limiting and heals spontaneously with reossification and reconstitution within a few years. Application of a below-knee weight-bearing cast may improve symptoms and is recommended, typically for 6-to-7 weeks.
History and etymology
It was first described in 1908 by Alban Köhler, a German radiologist (1874-1947) 1.
Usually, there is little difficulty in making the diagnosis. If symptoms persist then tarsal coalition should be sought.
- 1. Köhler A. Über eine häufige, bisher anscheinend unbekannte Erkrankung einzelner kindlicher Knochen. Münchener medizinische Wochenschrift. 1908, 55: 1923-1925.
- 2. Stanton BK, Karlin JM, Scurran BL. Köhler's disease. J Am Podiatr Med Assoc. 1992;82 (12): 625-9. - Pubmed citation
- 3. Sharp RJ, Calder JD, Saxby TS. Osteochondritis of the navicular: a case report. Foot Ankle Int. 2003;24 (6): 509-13. - Pubmed citation
- 4. Haller J, Sartoris DJ, Resnick D et-al. Spontaneous osteonecrosis of the tarsal navicular in adults: imaging findings. AJR Am J Roentgenol. 1988;151 (2): 355-8. doi:10.2214/ajr.151.2.355 - Pubmed citation
- 5. Rosenberg ZS, Beltran J, Bencardino JT. From the RSNA Refresher Courses. Radiological Society of North America. MR imaging of the ankle and foot. Radiographics. 2000;20 Spec No (suppl_1): S153-79. doi:10.1148/radiographics.20.suppl_1.g00oc26s153 - Pubmed citation