Kohler's Disease: Bone Pain in the Arch

Robert G. Parker
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Dr. Parker is a podiatrist and surgeon in Houston, TX who has been helping patients for more than 40 years.

Children's feetNo one enjoys having a child in pain. Children bounce back quickly from injuries and can handle a lot of wear and tear, but pain can limit them and impact their healthy development, too. It’s a fine balance deciding what discomfort is “normal” from a minor injury and what signals a more serious issue. Conditions like Kohler’s disease are rare, but they can cause serious pain and difficulty walking.

What Is It?

Kohler’s disease is an unusual bone problem that causes intense discomfort in the midfoot. One of the tarsal bones, the tarsal navicular, loses a large portion of its blood flow. This interruption in circulation causes the bone to deteriorate in a process called avascular necrosis. As the problem worsens, the tarsal navicular may break down and develop fractures—or even break up into fragments—before healing and solidifying.

This causes the foot to swell and become quite tender. The top of the foot may appear red and inflamed as well. Your child may develop a limp and try to avoid putting weight on the affected foot. Usually the symptoms are intermittent and may get worse after being active. Since the symptoms are similar to other problems, the condition is often misdiagnosed.

Is Your Child at Risk?

The problem can develop in a child as young as 2, but the highest risk is between ages 3 and 9. Boys are also far more likely to suffer from it than girls. No one is entirely sure what causes Kohler’s disease, but it may be related to how your child’s bones mature. The tarsal navicular is one of the last bones in the foot to mature from soft cartilage to hard bone tissue. If this process is delayed, pressure from walking and running around may pinch the bone and restrict its blood flow. The condition may have a genetic component as well, since the problem can run in families.

How to Help Your Child’s Foot Pain

The good news is that Kohler’s disease does not cause any permanent bone damage. Your son or daughter will eventually outgrow the issue. However, there are things you can do to help relieve your child’s discomfort now and keep his or her limbs healthy while you wait for that to happen. Dr. Robert Parker will need to carefully examine the foot to accurately diagnose the problem. This means using X-rays along with other tests to determine the health of the midfoot. Once the condition has been identified, you can begin therapies to help heal the lower limb.

Typically this disorder is handled conservatively. For a mild case, your child may simply need arch supports or heel wedges in his or her shoes. This helps distribute body weight evenly through the foot, so the tarsal navicular doesn’t suffer from excessive pressure. Icing the foot when it hurts may help relieve the immediate pain, too. Our staff may also recommend anti-inflammatory medications to help with the discomfort. In severe cases, the affected foot may need to be immobilized. Sometimes wearing a plaster cast can help limit the pressure on the midfoot and allow the bone to heal more quickly.

If your child is limping and struggling with arch discomfort, you may want to look into Kohler’s disease. The condition is rare, but it can impact your child’s walking during a crucial time in life. Help your child deal with the discomfort properly. Contact us at Parker Foot & Ankle in Houston to see how we can help relieve your child’s pain. Call (281) 497-2850 or contact us through our website to make an appointment.