Köhler disease

Köhler disease is an eponymous term referring to chilhood onset avascular necrosis of the navicular bone in the foot. Mueller Weiss syndrome is the adult counterpart of navicular bone avascular necrosis. 4,5

It typically presents in the paediatric population (4-6 years 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.

Plain radiograph
  • navicular may appear wafer-like (thinned) and fragmented
  • demonstrates patchy sclerosis (similar to avascular necrosis 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. 

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. 

It was first described in 1908 by A 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.

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Article information

rID: 9386
Section: Pathology
Synonyms or Alternate Spellings:
  • Kohler disease
  • Kohler's disease

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