This is test content. It hasn't been reviewed yet, and will be replaced with reviewed content.

Köhler's Disease

Bone and Joint Conditions· Also known as: Köhler disease, Kohler's disease, osteochondrosis of the navicularUpdated Nov 2026

Not reviewed yet: test content

At a Glance

Köhler's disease is a rare childhood foot condition. The navicular, a small bone on the inner midfoot, briefly loses its blood supply and then recovers and rebuilds. It mostly affects boys aged about 4 to 7 years, usually in one foot. The main symptom is midfoot pain that is worse with walking, often with a limp. It usually settles by itself. First-line care is rest or reduced weight-bearing, sometimes with a walking boot or a short leg cast, though it isn't clear yet how much these help. A limp always needs checking, because other causes must be ruled out first.

What is it?

Köhler's disease is a condition of childhood that affects the navicular, a small bone on the inside of the midfoot (the middle of the foot). For a time, the navicular loses part of its blood supply. The bone then weakens, and later it heals and rebuilds itself. This can cause pain and swelling on the inside of the midfoot.

It was first described by a doctor, Alban Köhler, in 1908. It is a rare foot condition, and because it is uncommon it can be missed or mistaken for something else. Köhler's disease usually settles by itself over time.

Who does it affect?

Köhler's disease mostly affects young children. It is seen most often in children aged about 4 to 7 years. Some are a little younger or older, from about 2 to 10 years of age. It is rare in older children.

Boys are affected far more often than girls. It affects roughly 4 to 6 boys for every girl.

It usually affects one foot. In some children, up to 20 to 25 per cent, both feet are involved. It is rare, and there is no exact figure for how many children get it. The numbers above are only rough guides, and they vary, from about 4 to 7 or 2 to 10 years of age, and from 20 to 25 per cent for both feet.

Signs and symptoms

The main sign is pain on the inside of the midfoot. It is usually worse when your child walks, runs or plays, and it may ease with rest. It often builds up gradually, though it can also start suddenly.

Most children also limp. There may be mild swelling that doesn't go away, and the navicular may be tender when pressed. Sometimes the skin looks a little red. How much it affects walking varies. Some children walk on the outer edge of the foot, and others are unable to walk.

Some children have no symptoms. In these cases the condition is found by chance on an x-ray.

Some signs are worth watching for. They are listed in the "When to see a podiatrist" section.

What causes it?

The exact cause isn't fully understood, and in most children no clear cause is found. The main idea is about squeezing. The navicular is the last foot bone to harden (turn from soft growing tissue into firm bone). It also sits at the top of the arch, where it takes a lot of pressure between the bones around it.

The middle of the navicular has a fairly poor blood supply, and the few small vessels that feed it can be squashed. As a child grows and puts more weight on the foot, the harder bones nearby may press on it and cut off its blood supply for a time.

This may help explain why young children are affected. The navicular hardens later in boys than in girls, which may be one reason boys are affected more often. A foot shape that puts extra stress on the navicular may play a part too. Growth, small repeated knocks and other factors may also play a part.

Nothing you did is known to have caused it.

How is it diagnosed?

Köhler's disease is diagnosed from your child's story, an examination and x-rays. They will ask when the pain began, whether walking worsens it and rest eases it, and about any injury, fever or feeling unwell. They will feel for tenderness and swelling over the navicular, and watch your child walk.

An x-ray is the main test. It often shows a flattened, dense navicular broken into pieces. Early x-rays can look normal, so if concern remains, your child should be sent on for further assessment.

Köhler's disease is only diagnosed once infection and a fracture have been ruled out, using age, blood tests and x-rays. Other things that can look similar include a stress fracture, tarsal coalition (two foot bones joined together), tendonitis and inflammatory arthritis. Normal x-rays or blood tests don't rule out a bone or joint infection, which can show few general signs.

The signs that need action are in the "When to see a podiatrist" section.

Treatment

Köhler's disease usually settles by itself, so care is simple and mostly eases symptoms. It is usually needed only when your child has pain or a limp.

Looking after it at home

Rest the foot and avoid high-risk activities. Ice can also be used. Your child's doctor may also suggest anti-inflammatory pain relief medicines (NSAIDs).

Treatment from your podiatrist

Your child's doctor may suggest a controlled ankle motion boot, or crutches (with or without weight on the foot). A short leg walking cast is for more severe symptoms. It may be worn for about 3 to 6 weeks, and for no more than 6 weeks, to avoid a stiff ankle. Rigid-sole shoes and arch supports are other options.

Agree with the doctor how long a boot or cast is used, and plan a review to catch any worsening or lack of improvement. It isn't yet known which option works best.

Other options

If symptoms aren't settling, the "When to see a podiatrist" section explains what to do. The review should include whether the diagnosis still fits. The GP can arrange an x-ray or refer your child to a specialist such as a paediatric orthopaedic surgeon (a children's bone surgeon). Referral to a paediatric orthopaedic surgeon may be offered if the pain is severe or lasts despite several months of care.

Surgery

Surgery is used only for severe pain after several months of other care. Risks include foot scars and tendon adhesion (a tendon sticking to nearby tissue). How well it works isn't clear yet, as children can also improve by themselves.

Recovery

The outlook is very good. Köhler's disease usually settles by itself, and the navicular rebuilds itself over time. On x-rays it typically looks completely healed by about 9 years of age. It isn't known to cause any long-term problems with the foot.

Even so, the pain and limp can last for several months, and in some children even years. Lasting symptoms can seriously affect a child's quality of life, so it is worth keeping an eye on how your child is going. If the pain or limp isn't improving, or is getting worse, see the "When to see a podiatrist" section.

If your child grows up and foot pain comes back in adulthood, other causes of the pain should be looked into: see the "When to see a podiatrist" section.

When to see a podiatrist

When to book

Book an appointment with your podiatrist if:

your pain hasn't improved after a few weeks of home care

When to get help sooner

Get urgent medical assessment (see your GP today, or go to an urgent care clinic or the nearest emergency department) if:

your child has a fever with a limp or a painful, red, hot or swollen joint, or seems very unwell with foot or leg pain: go straight away, without waiting for an appointment
your child suddenly has severe pain in one joint and is limping

See your GP soon if:

you have lost weight without trying
your child has a limp that hasn't improved after a week, limps without pain, or doesn't want to put weight on their foot

See your podiatrist or GP soon if:

your pain is getting worse, or doesn't settle with rest, less activity or pain relief

Frequently asked questions

Does my child need a cast?

Not always. A short leg walking cast is usually kept for more severe symptoms. A short time in one may shorten how long symptoms last, but long-term results are good whatever treatment is used. Your child's doctor can help you choose.

Will Köhler's disease go away by itself?

Usually, yes. The navicular heals and rebuilds, and most children recover fully with simple care. The pain and limp can take months to settle, so keep track of how your child is going and ask for a review if they aren't improving.

Can I tell if my child has Köhler's disease?

No, it needs a doctor's or podiatrist's assessment. Other causes of a limp must be ruled out first, so please don't self-diagnose. The signs that need action are in the "When to see a podiatrist" section.