Child With Foot Pain: Rule Out Kohler's Disease

There is an unusual foot condition your child may experience; if your child complains of foot pain or your child says his/her feet are "cold" these are classic symptoms of a condition known as Kohler's Disease.  (Dr. Kohler was a German physician and wrote the first report about this condition.)

This is a limited condition. Your child will outgrow it but the symptoms of Kohler's Disease include discomfort and possibly swelling. It affects one foot.

Children's Day - II
Image by carf via Flickr

What is happening, either through heredity, abnormal coagulation, or vascular problems is a small bone in the foot (the navicular bone) is not getting blood.  The medical term is "avascular necrosis".

The navicular bone is the last to harden and gets trapped between other solid bone as the child grows and gains weight.

Kohler Disease can happen as early as the age of 2, but is more common from 5-10 years.  It is more common with boys, but girls who do get it tend to be younger because their bones ossify earlier.  (This means bone density increase begins at an earlier age.)

The theory is that since the navicular bone is the last to ossify*, it may get compressed while still "spongy" bone as the child gains weight during the normal growth process.

navicular-bone-child-xray

Your child may also limp, or walk on the outside of the foot. Although not pleasant, this is not serious and it is a self-limiting problem.  The first thing to do is see a podiatrist for treatment to relieve the temporary discomfort.

Treatment for Kohler's Disease usually involves casting, soft arch supports, a heel wedge, or rest. Children with a cast usually feel better within a few months opposed to several months without a cast.  There is no need for surgery; the navicular bone eventually gets a normal blood supply.

If pain persists after traditional measures your child needs to be re-evaluated for other problems.

*ossify - to turn into bone, or bony tissue

image courtesy of http://westjem.com/images/kohlers-disease.html