Introduction
Kohler’s disease is a rare form of avascular necrosis affecting the navicular bone in the foot, primarily seen in children aged 3 to 7 years.(Trammell et al, 2025) While most cases resolve with conservative management, some may progress to pathological fractures or degenerative joint changes. This blog discusses a novel Kohler’s disease treatment approach using regenerative distraction arthroplasty, as detailed in a recent case report by (Slater et al, 2023).
What is Kohler’s Disease?
Kohler’s disease is a self-limiting condition characterised by temporary avascular necrosis of the navicular bone. It often presents with foot pain, limping, and tenderness along the medial arch. Males are affected more frequently than females, and the condition is typically diagnosed via X-ray, which may show fragmentation, sclerosis, or flattening of the navicular bone. (Trammell et al, 2025) Most cases improve with rest, immobilisation, or orthotic support. However, in rare instances, the disease can lead to complications such as pathological fractures or secondary arthritis.
Standard Treatment Approaches
Conservative management remains the first line of treatment for Kohler’s disease. This may include activity modification, non-steroidal anti-inflammatory drugs (NSAIDs), casting, or the use of supportive footwear. In most young patients, the navicular bone revascularises and remodels over time without surgical intervention. (Trammell et al, 2025) However, if conservative measures fail or if there is significant structural compromise, surgical options such as open reduction and internal fixation (ORIF) may be considered.
A Case of Complex Kohler’s Disease
The case report by (Slater et al, 2023) describes a 17-year-old female with advanced Kohler’s disease that resulted in a pathological fracture of the navicular bone. Initial treatment involved ORIF and bone grafting, which initially resolved symptoms. However, three years later, the patient developed painful peri-navicular arthritis. Given her young age and desire to avoid joint fusion, a regenerative approach was pursued using distraction arthroplasty.
Regenerative Distraction Arthroplasty
Distraction arthroplasty is a joint-preserving technique that involves mechanical joint distraction to stimulate cartilage regeneration. In this case, an external fixator was applied to the foot to offload the affected joints and create a microenvironment conducive to healing. (Slater et al, 2023) The process included arthroscopic debridement, injection of platelet-rich plasma, and gradual distraction over eight weeks. Follow-up imaging showed improved joint space and symptomatic relief, allowing the patient to return to normal activities without the need for fusion.
Conclusion
Kohler’s disease typically follows a benign course, but complex cases may require innovative treatments to preserve joint function and avoid fusion. Regenerative distraction arthroplasty offers a promising alternative for young patients with advanced disease. Further research and long-term follow-up are needed to validate its efficacy and refine patient selection criteria.
References
Trammell AP, Davis DD, Scott A. Kohler Disease. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507831/
Slater, G., Sambo, T., Slater, T., & Pozharova, V. (2023). Kohler’s Disease Case Report: Treatment with Regenerative Distraction Arthroplasty Technology. Journal of Clinical and Medical Research, 4(2), 1–12.
https://www.researchgate.net/publication/371043208_Kohler’s_Disease_Case_Report_Treatment_with_Regenerative_Distraction_Arthroplasty_Technology
Disclaimer: This blog is for informational purposes only and should not be considered medical advice. Please consult with your healthcare provider for any questions or concerns regarding your health. All surgical or invasive procedures involve potential risks. It is advisable to seek a second opinion from a suitably qualified healthcare professional before making any decisions.
