Kohler's Disease: How to Care for Your Child

Kids with Kohler's disease have pain and swelling on the inside part of the foot. They may limp or walk on the outside part of the foot. It happens in young kids (usually around 4–7 years old) due to a change in the shape of the navicular bone (a bone in the foot).

Kids with Kohler's disease are treated by an orthopedic (bone) specialist. The orthopedic specialist put a cast on your child to ease pain and help the foot heal. The navicular bone will heal completely within a few months without any lasting damage.

Follow your health care provider's advice for:

• Caring for the cast.

• Using crutches, if needed.

• Giving your child acetaminophen (Tylenol® or a store brand), ibuprofen (Advil^®, Motrin^®, or a store brand), or naproxen (Aleve^®, Naprosyn^®, or a store brand) as needed for pain. Follow the directions on the label for how much to give and how often.

• What activities to avoid (including sports and gym class) and when it's OK to go back to full activities.

Daily cast care:

• Check the area around the cast every day. Make sure the skin isn't scratched, and the toes aren't pale, blue, numb, or tingling.

• Check the edges of the cast. Make sure your child isn't picking at or removing the padding from the edges.

• Don't put anything in the cast. Make sure your child doesn't put toys, food, or anything else into it.

• Keep dirt, sand, lotion, and powder away from the cast. 

Keep the cast dry:

• No swimming.

• Younger children can get a sponge bath. For regular baths or showers, you can cover the cast with:

  • two plastic bags sealed at the top with a rubber band or tape

  • plastic wrap covered with a plastic bag that is sealed at the top

  • a waterproof cast protector

• If the cast gets splashed, blow air into it from a hair dryer on the cool setting.

Problems to watch for:

• Sharp cast edges: Put tape or moleskin (available at drugstores) on any rough spots.

• Itching: Tap lightly on the cast or use a hair dryer on the cool setting to blow air in and around the edges.

• Swelling: If the toes look puffy, raise the leg above the level of the heart for 1 hour. If the swelling doesn't get better, call your health care provider.

• Blisters, rashes, or raw spots appear on the skin around the cast.

• Your child has worsening pain or pain that isn't helped by pain medicine. 

• Your child has a fever.

• The cast gets wet, is damaged, or has a foul odor.

• The cast feels too tight.

• Your child can't feel or move the toes.

• Your child's toes turn white, purple, or blue.

What causes Kohler's disease? Experts aren't sure what causes it. It's possible that activities like walking, running, and jumping cause the growing navicular bone to lose some of its blood supply and become flattened. These changes cause pain, swelling, and tenderness on the inside of the foot and sometimes a limp.