eMedicine Specialties > Orthopedic Surgery > Foot & Ankle

Köhler Disease: Workup

Author: Bernardo Vargas, MD, Consulting Staff, Unité Pédiatrique de Chirurgie Orthopédique et Traumatologie (UPCOT), Department of Orthopedic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Contributor Information and Disclosures

Updated: Feb 5, 2009

Workup

Imaging Studies

  • X-rays (see Image 1)
    • The lateral view shows a flat tarsal scaphoid (see Image 2)
    • The space between the talus and the cuneiforms is not decreased.
    • Frequently, there is an irregular ossification of the tarsal navicular bone or radiologic changes that resemble Köhler disease, but the diagnosis must not be made in the absence of clinical signs.5,6
  • Bone scanning
    • Bone scans reveal a decreased uptake of radionuclide in the right midtarsal area.7
    • This exam is not necessary for the diagnosis.
  • If pain persists 6 months after casting, a magnetic resonance image (MRI) study or computed tomography (CT) scanning is necessary to exclude a tarsal coalition.8
Radiograph from a 16-year-old patient who had K&#...

Radiograph from a 16-year-old patient who had Köhler disease. Normal x-rays at adulthood are the rule for Köhler disease.

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Radiograph from a 16-year-old patient who had K&#...

Radiograph from a 16-year-old patient who had Köhler disease. Normal x-rays at adulthood are the rule for Köhler disease.




Radiograph from a patient with Köhler diseas...

Radiograph from a patient with Köhler disease. This image is typical for Köhler disease. Note the flat aspect of the tarsal scaphoid.

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Radiograph from a patient with Köhler diseas...

Radiograph from a patient with Köhler disease. This image is typical for Köhler disease. Note the flat aspect of the tarsal scaphoid.


More on Köhler Disease

Overview: Köhler Disease
Workup: Köhler Disease
Treatment: Köhler Disease
Follow-up: Köhler Disease
Multimedia: Köhler Disease
References
Further Reading
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References

  1. Kohler A. Uben eine häubige bisher ansheinend unbekannte Erkrankung einzelner kindlicher Knochen Verh deutsch Röntg-Ges 1908;4:110.

  2. DiGiovanni CW, Patel A, Calfee R, Nickisch F. Osteonecrosis in the foot. J Am Acad Orthop Surg. Apr 2007;15(4):208-17. [Medline].

  3. Khan AQ, Sherwani MA, Gupta K, Siddiqui YS, Hali NZ. Kohler's disease. Saudi Med J. Sep 2008;29(9):1357-8. [Medline].

  4. Waugh W. The ossification and vascularisation of the tarsal navicular and their relation to Köhler's disease. J Bone Joint Surg Br. Nov 1958;40-B(4):765-77. [Medline]. [Full Text].

  5. Berard J, Fournet-Fayard J. [Idiopathic ostonecrosis of the scaphoid tarsal bone (Köhler's second disease)] [French]. Rev Rhum Mal Osteoartic. Feb 1983;50(2):163-5. [Medline].

  6. Williams GA, Cowell HR. Köhler's disease of the tarsal navicular. Clin Orthop Relat Res. Jul-Aug 1981;158:53-8. [Medline].

  7. Khoury J, Jerushalmi J, Loberant N, Shtarker H, Militianu D, Keidar Z. Kohler disease: diagnoses and assessment by bone scintigraphy. Clin Nucl Med. Mar 2007;32(3):179-81. [Medline].

  8. Gips S, Ruchman RB, Groshar D. Bone imaging in Kohler's disease. Clin Nucl Med. Sep 1997;22(9):636-7. [Medline].

  9. Ippolito E, Ricciardi Pollini PT, Falez F. Köhler's disease of the tarsal navicular: long-term follow-up of 12 cases. J Pediatr Orthop. Aug 1984;4(4):416-7. [Medline].

  10. Ertel AN, O'Connell FD. Talonavicular coalition following avascular necrosis of the tarsal navicular. J Pediatr Orthop. Aug 1984;4(4):482-4. [Medline].

  11. Borges JL, Guille JT, Bowen JR. Köhler's bone disease of the tarsal navicular. J Pediatr Orthop. Sep-Oct 1995;15(5):596-8. [Medline].

  12. Khan AQ, Sherwani MA, Gupta K, Siddiqui YS, Hali NZ. Kohler's disease. Saudi Med J. Sep 2008;29(9):1357-8. [Medline].

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Keywords

Köhler disease, Köhler's disease, avascular necrosis, avascular necrosis of tarsal navicula, osteochondritis of tarsal navicula, osteochondroses, osteonecrosis of the foot, foot osteonecrosis. limping child

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Contributor Information and Disclosures

Author

Bernardo Vargas, MD, Consulting Staff, Unité Pédiatrique de Chirurgie Orthopédique et Traumatologie (UPCOT), Department of Orthopedic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Disclosure: Nothing to disclose.

Medical Editor

Heidi M Stephens, MD, Associate Professor, Department of Surgery, Division of Orthopedic Surgery, Director of Diabetic Foot Clinic, Assistant Dean for Clinical Outreach, University of South Florida College of Medicine; Courtesy Joint Associate Professor, Department of Environmental and Occupational Health, University of South Florida College of Public Health
Heidi M Stephens, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, and Florida Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Shepard R Hurwitz, MD, Executive Director, American Board of Orthopaedic Surgery
Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FAAOS, Chairman, J Vernon Luck Distinguished Professor, Department of Orthopedic Surgery, University of Missouri
Jason H Calhoun, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, and American Orthopaedic Foot and Ankle Society
Disclosure: Nothing to disclose.

 
 
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