What causes pain in the arch of the foot after Running
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Kohler’s Disease is a condition that effects the Navicular Bone which is located on the medial arch of the foot. It occurs in children, commonly between the ages of 3-7 but it can occur in those older than this.
Kohler’s Disease is more common in boys than girls and patients often report feeling pain on the inner aspect of their foot, they may limp when walking and there is often visible swelling on the foot. There is pain on palpation of the medial arch of the foot and running or hopping often worsens the pain.
The exact cause of Kohler’s Disease is unknown but it we know that it is a result of decreased blood flow to the Navicular bone resulting in avascular necrosis of the bone.
We know that the Navicular Bone is the last bone in the foot to fully form and it is believed that as the surrounding bones fully form and ossify, in some individuals they can compress the developing navicular bone, leading to reducing in blood supply to the area.
A consultation with a Musculoskeletal Physician or a Paediatric Physical Therapist is recommended if you are suspicious of having Kohler’s Disease. A clinical examination can identify the location of pain and it should be compliments with a x-ray to achieve a clinical diagnosis. An x-ray can identify necrosis of the navicular bone and rule other other conditions with a similar clinical presentation such as a tarsal coalition.
A Paediatric Physical Therapist is in an excellent position to offer appropriate treatment for Kohler’s Disease. In severe cases the patient may be recommended a period of time in a cast or a walker boot for 4-6 weeks until their pain has subsided.
Upon removal of the walker boot, advise on the most appropriate supportive footwear is recommended. Strengthening exercises for the foot and ankle are recommended for muscular weakness that develops from the time spent in a boot.
For young patients who have flat feet, insoles may be recommended alongside strengthening and stretching exercises.