Osteochondroses are noninflammatory, noninfectious derangements of bony growth at various ossification centers.
Köhler bone disease usually affects children aged 3 to 5 years (more commonly boys) and is unilateral. The foot becomes swollen and painful; tenderness is maximal over the medial longitudinal arch. Weight bearing and walking increase discomfort, and gait is disturbed.
On x-ray, the navicular bone is initially flattened and sclerotic and later becomes fragmented, before reossification. X-rays comparing the affected side with the unaffected side help assess progression.
The course is chronic, but the disease rarely persists ≥ 2 years. Rest, pain relief, and avoiding excessive weight bearing are required. The condition usually resolves spontaneously with no long-term sequelae. In acute cases, a few weeks of wearing a below-knee walking plaster cast, well molded under the longitudinal arch, may help.