Kohler Disease Treatment & Management

Updated: May 28, 2021
  • Author: Bernardo Vargas, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS  more...
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Medical Therapy

A walking short leg cast with toe extension is recommended. Total cast time is approximately 6-8 weeks. The cast is better in moderate varus (10-15º) that is associated with moderate equinus (10-20º). In this position, the navicular is relaxed from posterior tibialis strain. Arch supports can be prescribed after the cast period and used for an average of 6 months. In mild cases, soft arch supports may be the only treatment necessary.

Surgery is not indicated for Köhler disease. 



In 1984, Ertel and O'Connell reported a case of acquired talonavicular coalition that followed avascular necrosis (AVN) of the tarsal navicular bone. [15] This complication is very rare.


Long-Term Monitoring

In treated patients, symptoms may last less than 3 months. [11]  In untreated patients, symptoms may be present for 15 months. Because immobilization in a short leg cast decreases the duration of symptoms, treating all patients for at least 6 weeks is recommended.

If pain persists after a 6-week period of casting, a new cast must be applied for 6 supplementary weeks. [16]  If pain does not disappear after the cast period, other causes of foot pain, including talar coalition or an accessory navicular, should be investigated. [17]