Kohler Disease Workup

  • Author: Bernardo Vargas; Chief Editor: Jason H Calhoun, MD, FACS   more...
 
Updated: Feb 17, 2012
 

Imaging Studies

  • X-rays
    • See the image belowRadiograph from a 16-year-old patient who had KöhlRadiograph from a 16-year-old patient who had Köhler disease. Normal x-rays at adulthood are the rule for Köhler disease.
    • The lateral view shows a flat tarsal scaphoid (see the image below).Radiograph from a patient with Köhler disease. ThiRadiograph from a patient with Köhler disease. This image is typical for Köhler disease. Note the flat aspect of the tarsal scaphoid.
    • 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]
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Contributor Information and Disclosures
Author

Bernardo Vargas  MD, Consulting Staff, Department of Orthopedic Surgery, University Hospital of Geneva, Switzerland

Disclosure: Nothing to disclose.

Specialty Editor Board

Heidi M Stephens, MD, MBA  Associate Professor, Department of Surgery, Division of Orthopedic Surgery, 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, MBA 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

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

Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS  Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association

Disclosure: Nothing to disclose.

Additional Contributors

Dr. Mark Clayer, MD, MBBS, FRACS, FAOrthA, is gratefully acknowledged for the contributions made to this article.

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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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 disease. This image is typical for Köhler disease. Note the flat aspect of the tarsal scaphoid.
 
 
 
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