Musculoskeletal System ORGAN SYSTEMS

Kohler disease

Rare, self-limiting, avascular necrosis of the navicular bone.


Pain & swelling of the medial midfoot with associated osteochondrosis or avascular necrosis of the tarsal navicular.

Eponymous osteochondritis:

Osteochondritis is a painful type of osteochondrosis where the cartilage or bone in a joint is inflamed
  • Kienbock disease (lunate)
  • Panner’s disease (capitulum)
  • Sever’s disease (calcaneum)
  • Kohler disease (navicular)

Kohler disease was first described by Alban Kohler in 1908 as an avascular necrosis of the navicular bone.


Navicular is the last tarsal bone to ossify and can get compressed between the already ossified talus and cuneiforms when the child becomes heavier. This in turn compresses the navicular bone’s perichondral ring of blood vessels, producing ischemia of the central spongy bone and avascular necrosis. The prognosis remains excellent owing to this radial arrangement of blood supply.

Clinical features

  • Dorsomedial midfoot pain
  • Physical examination:
    • Point tenderness over navicular + redness, warmth, and swelling
    • Antalgic limp (walk on lateral side of foot)



  • Collapsed, flat, and radiodense navicular bone
Radiograph of foot. Arrows point to the navicular bone with avascular necrosis | Shastri, N., Olson, L., & Fowler, M. (2012). Kohler’s Disease. The western journal of emergency medicine, 13(1), 119–120.


  • Pain management
  • Soft arch supports or medial heel wedge
  • Severe cases: Short leg walking cast (for 4-6 weeks)

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