Conservative Management of Kohler's Disease: A Case Report

Introduction: Kohler's disease is a rare, self-limiting, avascular necrosis of the navicular bone commonly seen male child 4-6yrs of age. Case Report: A 7-year-old boy presented with intermittent right foot pain for 1 week. Pain worsened the previous day after playing outside following which he was unable to bear weight on the right foot. On examination, he had pain and tenderness over his right dorso-medial midfoot with no local skin changes. He walked with an antalgic gait with weight bearing on the lateral aspect of the foot. His right foot radiograph and CT showed a collapsed, flat, and radio-dense navicular bone. He was managed conservatively with short leg POP cast for 8 weeks in moderate varus (150) and equinus (200) and analgesics. After 8 weeks of POP cast patient was given arch support for 6 months. After a follow up of 14 months he had normal bone growth with no pain. Conclussion: Osteonecrosis of navicular bone i.e. Kohler's disease is managed conservatively with short leg POP cast for 6 to 8 weeks in moderate varus (100-150) and equinus (100-200), analgesics and rest. Arch support can be prescribed following the cast period for 6 months. There is normal bone growth of navicular bone following this treatment.