KÖHLER BONE DISEASE
Köhler bone disease is an osteochondrosis of the navicular bone in the foot. Patients often present between two and eight years of age, and boys are three to five times more likely to be affected.27 The etiology is unknown, and there is usually no history of previous trauma. Mid-foot pain and a limp are the most common presenting symptoms. There is point tenderness over the navicular bone on examination.27 There may be mild swelling and warmth over the dorsal midfoot.28 The diagnosis is mainly clinical; however, plain radiographs usually demonstrate navicular sclerosis, flattening, and fragmentation.28 It is a self-limited condition and symptoms will eventually resolve.27,29 Recent reviews have shown that a short leg cast for up to eight weeks accelerates resolution of symptoms, although long-term outcomes are favorable regardless of treatment.27,30