Köhler Osteochondrosis

Osteochondrosis of the tarsal navicular (Köhler disease) is characterized by sclerosis and diminished size of the tarsal navicular, sometimes called the "Alka-Seltzer-on-end appearance." There is usually loss of the normal trabecular pattern of the navicular.

Because abnormalities in the size and shape of the normal navicular ossification center may lead to an identical radiographic appearance, the diagnosis requires the presence of pain and tenderness in the area of the tarsal navicular associated with the radiographic features described above.

There is a male-to-female ratio of 5:1. Patients are usually between 4 and 6 years of age and most commonly present with pain and a limp. Physical examination most commonly reveals tenderness over the tarsal navicular. 20% of cases are bilateral.

While Köhler disease is self-limited, cast immobilization may result in faster resolution of symptoms.

References

Canale ST. Osteochondroses and Related Problems of the Foot and Ankle In: DeLee JC, Drez D, eds. DeLee and Drez's Orthopaedic Sports Medicine. 2nd ed. Philadelphia , Pa. : Saunders; 2003: pp. 2587-2623.