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Does immobilisation improve outcomes in children with Köhler’s disease?
  1. Riki Houlden
  1. East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
  1. Correspondence to Dr Riki Houlden, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK; riki.houlden{at}

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Clinical bottom lines

  • Immobilisation in a cast may result in a shorter duration of pain for children with Köhler’s disease. (Grade C)

  • The use of a short leg cast for at least 8 weeks appears to produce the best results. (Grade C)

  • Most patients will be asymptomatic with normal radiographic and biochemical findings at long-term follow-up regardless of treatment modality. (Grade C)


A 5-year-old boy presents to the orthopaedic clinic with foot pain and a limp. Tenderness is noted in the tarsal navicular area, and plain films demonstrate narrowing and increased density of the navicular. The diagnosis of Köhler’s disease is made. A colleague comments that immobilisation is the typical management but some elect to manage conservatively. You wonder what the effect of immobilisation is on patient outcomes.

Structured clinical question

In children with Köhler’s disease (patient), does immobilisation (intervention) compared …

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  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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