Köhler's disease of the tarsal navicular.

Twenty patients with Köhler's disease of the tarsal navicular were treated at the Alfred I. duPont Institute between 1948 and 1974. Three patients with asymptomatic, irregular ossification of the tarsal navicular also were investigated to evaluate the various modes of therapy and the long-term effects of various treatment programs. Symptomatic or true Köhler's disease must be differentiated clinically from asymptomatic roentgenographic changes resembling Köhler's osteochondrosis. The patients showed a significant decrease in morbidity with the use of a short-leg cast for an an eight-week period. Whereas patients who were not treated in a short-leg cast had symptoms for an average duration of 15 months, treated patients had symptoms for less than three months. Notwithstanding the decrease in morbidity with the use of a short-leg walking cast, the long-term results suggest that all of our patients eventually had spontaneous reconstitution of the navicular and excellent recovery of function.