Köhler Disease

What is Köhler Disease?

There are two kinds of Kohler disease and both affect the foot in growing children and adolescent. They are called Kohler I and Kohler II (or Freiberg Disease) and belong to the family of Osteochondrosis.

Other types of osteochondrosis are: Legg-Calve-Perthes disease, Osgood-Schlatter disease, Sever’s Disease

Kohler I is a rare bone disorder and it is the osteochondrosis of the tarsal navicular. It is usually a unilateral pathology that affects children aged between 3 and 8 years and males more often than females.

What are Köhler Disease symptoms?

Köhler’s disease can be asymptomatic.

When present, clinical manifestations are pain, which can sometimes cause limping, and a slight swelling in the inside of the foot.

What causes Köhler Disease?

The cause of Köhler disease is still unknown. There is no evidence that it is hereditary but recently some orthopedic specialists started to believe that Kohler’s disease may be linked to an injury in the area around the navicular bone in the foot.

How is Köhler Disease diagnosed?

Clinical examination after medical history is completed with Köhler disease is diagnosed with an X-ray of the foot that shows a characteristic sclerosis, fragmentation, and flattening of tarsal navicular.

It is always advisable to perform X-ray on both feet.

Köhler Disease treatments

Kohler’s disease typically resolves without treatment within 18-24 months.

However, during the 2 or 3 months when pais is more intense, rest and avoidance of weight-bearing activities are suggested to alleviate some of the symptoms.

In some cases, a walking cast or a plaster or an insole to support the arch and lift the longitudinal arch of the foot may also be recommended in order to reduce weight-bearing on the tarsal navicular bone and to gradually start sport activity

What is Köhler Disease II (also known as Freiberg Disease)

Kohler disease II in is an Osteochondrosis that affects the second metatarsal bone and mainly occurs in female.

The disease occurs usually during the late childhood or adolescence, but, unfortunately, symptoms appear later.

What causes Freiberg Disease

The process is not well understood, but is usually been thought to be a vascular problem after repetitive stresses. The Second metatarsal head doesn’t receive enough blood and oxygen, thus causing tissue destruction (ischemia). As a consequence of that the bone loses strength collapses and deforms.

Freiberg Disease Symptoms

Patients usually have a painful foot which may be tender toward the front. Walking or doing weight-bearing exercise can exacerbate pain and discomfort.

Freiberg Disease Diagnosis

In the early stage, x-rays of the metatarsal head don’t show any clear changes.

Later radiogram makes it clear the deformation, flattening, thickening and fragmentation of the bone.

Freiberg Disease Treatments

In most cases pain passes off spontaneously.

Anyway the doctor may suggest to rest the joint, decreasing or stopping activity. Also the use of medications such as nonsteroidal anti-inflammatory drugs may be recommended.

Unlike other “growing pains”, in adulthood, the foot may develop a form of localized arthrosis at the base of the second metatarsal that may require surgery.

Several surgical options may be used. The orthopedic surgeon will suggest the best solution depending on the situation and on the progression of the disease.

About Professor Portinaro’s experience

In case of surgical treatment, minimally plantar wedge flexion osteotomy is performed percutaneously.

Non weight bearing of the front part of the foot is recommended for 5 weeks using special shoes that allows walking anyway.