Köhler disease
Updates to Article Attributes
Köhler disease is an eponymous term referring to childhood-onset osteonecrosis of the navicular in the foot. Müeller-Weiss syndrome is the adult counterpart of navicular osteonecrosis 4,5.
Epidemiology
Köhler disease typically presents in the paediatric population (4-6 years of age) and there is a recognised male predilection.
Pathology
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. The central 1/3 of navicular is a watershed area and it is prone more to avascular necrosis or stress fractures.
Radiographic features
Plain radiograph
the navicular may appear wafer-like (thinned) and fragmented
demonstrates patchy sclerosis (similar to osteonecrosis elsewhere)
often associated soft tissue swelling
CT/MRI
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 re-ossification and reconstitution within a few years. Application of a below-knee weight-bearing cast may improve symptoms and is recommended, typically for 6-7 weeks.
History and etymology
It was first described in 1908 by Alban Köhler, a German radiologist (1874-1947) 1,6. Interestingly, the radiograph with which Köhler made his original case description is now not thought to be Köhler disease 7!
Differential diagnosis
Usually, there is little difficulty in making the diagnosis. If symptoms persist then tarsal coalition should be sought. This is often mis interpreted as infection.
See also
-<p><strong>Köhler disease</strong> is an eponymous term referring to childhood-onset <a href="/articles/osteonecrosis-2" title="Osteonecrosis">osteonecrosis</a> of the <a href="/articles/navicular" title="Navicular">navicular</a> in the foot. <a href="/articles/muller-weiss-syndrome" title="Mueller-Weiss disease">Müeller-Weiss syndrome</a> is the adult counterpart of navicular osteonecrosis <sup>4,5</sup>.</p><h4>Epidemiology</h4><p>Köhler disease typically presents in the paediatric population (4-6 years of age) and there is a recognised male predilection.</p><h4>Pathology</h4><p>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. The central 1/3 of navicular is a watershed area and it is prone more to avascular necrosis or stress fractures. </p><h4>Radiographic features</h4><h5>Plain radiograph</h5><ul>-<li><p>the navicular may appear wafer-like (thinned) and fragmented</p></li>-<li><p>demonstrates patchy sclerosis (similar to osteonecrosis elsewhere)</p></li>-<li><p>often associated soft tissue swelling</p></li>-</ul><h5>CT/MRI</h5><p>Cross-sectional imaging is usually not required but may be necessary if pain persists or the diagnosis is not clear. </p><h4>Treatment and prognosis</h4><p>Köhler disease often tends to be self-limiting and heals spontaneously with re-ossification and reconstitution within a few years. Application of a below-knee weight-bearing cast may improve symptoms and is recommended, typically for 6-7 weeks. </p><h4>History and etymology</h4><p>It was first described in 1908 by <a href="/articles/alban-kohler">Alban Köhler</a>, a German radiologist (1874-1947) <sup>1,6</sup>. Interestingly, the radiograph with which Köhler made his original case description is now not thought to be Köhler disease <sup>7</sup>!</p><h4>Differential diagnosis</h4><p>Usually, there is little difficulty in making the diagnosis. If symptoms persist then <a href="/articles/tarsal-coalition">tarsal coalition</a> should be sought. This is often mis interpreted as infection.</p><h4>See also</h4><ul>-<li><p><a href="/articles/muller-weiss-syndrome" title="Mueller-Weiss disease">Müeller-Weiss syndrome</a></p></li>-<li><p><a href="/articles/osteonecrosis-2" title="Osteonecrosis">osteonecrosis</a></p></li>- +<p><strong>Köhler disease</strong> is an eponymous term referring to childhood-onset <a href="/articles/osteonecrosis-2" title="Osteonecrosis">osteonecrosis</a> of the <a href="/articles/navicular" title="Navicular">navicular</a> in the foot. <a href="/articles/muller-weiss-syndrome" title="Mueller-Weiss disease">Müeller-Weiss syndrome</a> is the adult counterpart of navicular osteonecrosis <sup>4,5</sup>.</p><h4>Epidemiology</h4><p>Köhler disease typically presents in the paediatric population (4-6 years of age) and there is a recognised male predilection.</p><h4>Pathology</h4><p>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. The central 1/3 of navicular is a watershed area and it is prone more to avascular necrosis or stress fractures. </p><h4>Radiographic features</h4><h5>Plain radiograph</h5><ul>
- +<li><p>the navicular may appear wafer-like (thinned) and fragmented</p></li>
- +<li><p>demonstrates patchy sclerosis (similar to osteonecrosis elsewhere)</p></li>
- +<li><p>often associated soft tissue swelling</p></li>
- +</ul><h5>CT/MRI</h5><p>Cross-sectional imaging is usually not required but may be necessary if pain persists or the diagnosis is not clear. </p><h4>Treatment and prognosis</h4><p>Köhler disease often tends to be self-limiting and heals spontaneously with re-ossification and reconstitution within a few years. Application of a below-knee weight-bearing cast may improve symptoms and is recommended, typically for 6-7 weeks. </p><h4>History and etymology</h4><p>It was first described in 1908 by <a href="/articles/alban-kohler">Alban Köhler</a>, a German radiologist (1874-1947) <sup>1,6</sup>. Interestingly, the radiograph with which Köhler made his original case description is now not thought to be Köhler disease <sup>7</sup>!</p><h4>Differential diagnosis</h4><p>Usually, there is little difficulty in making the diagnosis. If symptoms persist then <a href="/articles/tarsal-coalition">tarsal coalition</a> should be sought. This is often mis interpreted as infection.</p><h4>See also</h4><ul>
- +<li><p><a href="/articles/muller-weiss-syndrome" title="Mueller-Weiss disease">Müeller-Weiss syndrome</a></p></li>
- +<li><p><a href="/articles/osteonecrosis-2" title="Osteonecrosis">osteonecrosis</a></p></li>
Image 12 X-ray (Oblique) ( create )
