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Köhler disease typically presents in the pediatric population (4-6 years of age) and there is a recognized male predilection.
Although the etiology 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 third of the navicular is a watershed area and it is prone more to avascular necrosis and stress fractures ref.
the 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 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.
Usually, there is little difficulty in making the diagnosis. If symptoms persist then findings of tarsal coalition should be sought. This can be misinterpreted as infection ref.
- 1. Köhler A. Über eine häufige, bisher anscheinend unbekannte Erkrankung einzelner kindlicher Knochen. Münchener medizinische Wochenschrift. 1908, 55: 1923-1925.
- 2. Stanton B, Karlin J, Scurran B. Köhler's Disease. J Am Podiatr Med Assoc. 1992;82(12):625-9. doi:10.7547/87507315-82-12-625 - Pubmed
- 3. Sharp R, Calder J, Saxby T. Osteochondritis of the Navicular: A Case Report. Foot Ankle Int. 2003;24(6):509-13. doi:10.1177/107110070302400611 - Pubmed
- 4. Haller J, Sartoris D, 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
- 5. Rosenberg Z, Beltran J, Bencardino J. 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
- 6. Alban Köhler 1874–1947. Radiology. 1948;50(4):545-6. doi:10.1148/50.4.545b
- 7. Jürgen Freyschmidt. Freyschmidt's "Koehler/Zimmer" Borderlands of Normal and Early Pathologic Findings in Skeletal Radiography. (2003) ISBN: 9781588901507 - Google Books