Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Balance Foot & Ankle offers same-day appointments for urgent foot and ankle conditions across Southeast Michigan — but the most important factor in outcomes isn’t getting seen quickly. Our podiatrists explain what to do in the first 24-48 hours before your appointment that most patients skip entirely. Call (810) 206-1402 — expert podiatric care across Michigan.
| Feature | Kohler Disease | Accessory Navicular (Type II) | Navicular Stress Fracture | Tarsal Coalition |
|---|---|---|---|---|
| Age at presentation | 3–7 years (boys 80%) | 10–16 years (girls more symptomatic) | Adolescents and young athletes | 8–16 years |
| Sex predominance | Boys 4:1 | Girls more symptomatic | Male athletes (track, basketball) | Equal |
| Pain location | Medial midfoot, navicular | Medial midfoot, medial navicular tuberosity | Dorsal navicular, central third | Medial midfoot or subtalar region |
| X-ray finding | Sclerosis, flattening, fragmentation of navicular | Accessory ossicle at medial navicular | May be normal early; MRI/CT needed | Bony or fibrous bar at coalition site |
| MRI finding | Bone marrow edema; navicular density change | Fibrocartilaginous synchondrosis with edema | Stress fracture line through navicular body | Fibrous or bony coalition bridging |
| Prognosis | Excellent — full spontaneous healing expected by age 10 | Variable — 30–40% need surgery (Kidner) | Good with NWB cast; risk of nonunion if missed | Good with resection; coalition type-dependent |
| Definitive treatment | Short leg cast 4–8 weeks; resolves fully | Orthotics; Kidner procedure if failed | NWB cast 6–8 weeks; surgery if nonunion | Coalition resection or triple arthrodesis (late) |
| Age | Kohler Disease Natural History | Clinical Milestone | Parental Guidance |
|---|---|---|---|
| 3–4 years | Navicular ossification irregular, sclerotic; pain begins | Limping; antalgic gait; medial foot tenderness | Shoe modification; limit impact activity |
| 5–6 years | Navicular fragmented or flattened on X-ray | Symptomatic period; short leg cast 4–8 weeks provides relief | Cast walking is safe; school attendance continues |
| 6–8 years | Revascularization and reossification begin | Symptoms diminish; X-ray improving | Resume activity as tolerated; protective footwear |
| 8–10 years | Navicular fully reconstituted; normal architecture restored | Pain-free; normal foot function | No long-term restrictions; full sports participation |
| Adult follow-up | No residual deformity or arthritis in 95%+ of cases | Normal midfoot mechanics | No ongoing treatment needed |
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What Is Köhler Disease?
Köhler disease is avascular necrosis (AVN) of the tarsal navicular — the boat-shaped bone at the apex of the medial longitudinal arch that articulates with the talus proximally and the three cuneiforms distally. The navicular is the last foot bone to ossify and has a single primary blood supply from its dorsal surface; this relative vascularity makes it vulnerable to ischemic disruption during periods of rapid skeletal growth and high mechanical loading. When the blood supply is interrupted — temporarily and for reasons that remain incompletely understood — the navicular undergoes the classic AVN sequence: ischemia, bone death, subchondral collapse, and eventual revascularization and reossification.
The condition was first described by German radiologist Alban Köhler in 1908 and remains relatively uncommon, affecting approximately 1 in 1,000 children. It predominantly affects boys (male:female ratio approximately 4:1) between ages 2 and 9, most commonly presenting at ages 3–7 when the navicular is actively ossifying and mechanical loading first becomes significant with running and jumping activity.
Causes and Risk Factors
The precise etiology of Köhler disease remains debated. The predominant hypothesis involves mechanical compression of the developing navicular — during the growth spurt, the navicular ossifies from a single center and must simultaneously accommodate the compressive forces of body weight and the tensile forces of the posterior tibial tendon (which inserts partly on the navicular). If mechanical loading exceeds the developing bone’s vascular tolerance, ischemic necrosis follows.
Risk factors include male sex, obesity (increased mechanical loading), and a family history of the condition. Bilaterality occurs in approximately 25% of cases. There is no known association with previous trauma, systemic diseases, or specific activities — distinguishing Köhler disease from secondary causes of navicular AVN in adults (such as steroid use or sickle cell disease).
Presentation: How Children with Köhler Disease Present
Children typically present with a limp and complaint of medial midfoot or arch pain that has been present for days to weeks. The gait pattern is characteristically antalgic with in-toeing — the child rotates the foot inward to roll weight off the medial arch and painful navicular. Parents often describe the child as “walking on the outside of the foot” or “not wanting to run anymore.” Physical examination reveals localized tenderness and sometimes mild swelling over the navicular on the dorsomedial midfoot. Passive midfoot inversion and eversion may reproduce pain. Neurological examination and ankle stability are normal.
The differential diagnosis includes tarsal coalition (which typically presents in adolescents, not young children), navicular stress fracture (rare in this age group), flexible flatfoot (bilateral, no point tenderness), and Sever’s disease (posterior heel, not midfoot). The diagnosis is confirmed with weight-bearing foot radiographs.
Radiographic Appearance of Köhler Disease
X-ray findings of Köhler disease are pathognomonic: the affected navicular appears flattened, sclerotic (uniformly dense), and fragmented compared to the contralateral normal navicular — which shows a well-rounded, smooth ossification center. The navicular may be reduced to a thin wafer of dense bone at the height of the disease. MRI is not routinely required for diagnosis but confirms marrow edema and avascular changes when radiographic findings are equivocal or when the clinical picture is atypical.
Important: some degree of irregular or delayed navicular ossification is a normal radiographic finding in young children — not every irregular navicular appearance represents Köhler disease. The combination of radiographic changes with clinical symptoms (pain, tenderness, limp) is required to confirm the diagnosis. Incidental navicular irregularity in an asymptomatic child is a normal variant.
Treatment: Immobilization Accelerates Recovery
Köhler disease is a self-limiting condition — the navicular invariably reossifies and returns to normal shape and size, typically within 2 years. However, the period of active AVN is often significantly painful and functionally limiting. Studies demonstrate that symptomatic treatment with cast immobilization reduces the duration of symptoms and limping compared to activity restriction alone.
Dr. Biernacki’s treatment protocol for symptomatic Köhler disease includes a short-leg walking cast or orthotic boot for 6–8 weeks during the active painful phase. This off-loads the navicular, reduces mechanical stress at the ischemic bone, and hastens symptom resolution. After immobilization, transition to a medial arch-supporting orthotic within a stiff-soled shoe provides continued off-loading during the reossification phase. Activity modification — avoiding high-impact running and jumping sports during active phases — is recommended but need not be permanent; most children return to full athletic activity within 12–18 months of diagnosis.
Long-term outcomes are excellent: multiple studies confirm that children with properly treated Köhler disease have no residual deformity, functional limitation, or increased risk of midfoot arthritis as adults. Parents can be reassured that this is not a condition with permanent consequences when managed appropriately.
Köhler Disease vs. Müller-Weiss Syndrome
Müller-Weiss syndrome is the adult equivalent of navicular AVN — occurring in adults ages 40–60, typically after minor trauma, and with a far worse prognosis than childhood Köhler disease. Adult navicular AVN leads to progressive collapse, medial midfoot arthritis, and often requires surgical reconstruction with navicular fusion or bone grafting. The favorable prognosis of Köhler disease in children reflects the notable remodeling capacity of the skeletally immature navicular — capacity that is absent in the adult bone.
Frequently Asked Questions
Will my child have long-term foot problems from Köhler disease?
No — with appropriate treatment, Köhler disease resolves completely without long-term consequences. Follow-up studies of adults who had Köhler disease as children show normal navicular architecture, normal foot function, and no increased arthritis risk. The prognosis is among the most favorable of any pediatric osteochondrosis.
How long does Köhler disease last?
The active painful phase typically lasts 3–12 months without treatment. Immobilization significantly shortens this to 6–8 weeks in many cases. Full radiographic reossification takes 1–2 years from diagnosis, though children are typically symptom-free long before X-rays normalize. Dr. Biernacki monitors radiographic progress at 3–6 month intervals until reossification is complete.
Can Köhler disease come back?
Recurrence after complete reossification is exceptionally rare. Once the navicular has revascularized and the ossification center has fully reconstituted, the bone is structurally normal. Occasional children have a protracted course with intermittent pain over 18–24 months, but this represents the natural disease course rather than recurrence after healing.
Dr. Tom's Product Recommendations
Stride Rite 360 Toddler Arch Support Sneaker
⭐ Highly Rated
Pediatric supportive shoe with built-in arch support and stable heel counter — appropriate footwear for children with Köhler disease transitioning out of cast immobilization. The rigid midsole reduces navicular stress during the reossification phase without full cast restriction.
Dr. Tom says: “Dr. Biernacki recommended supportive shoes after my son’s Köhler disease cast came off. These Stride Rites have excellent arch support and he transitioned back to normal activity over three months without recurring pain.”
Children with Köhler disease in the post-immobilization reossification phase
Active phase of Köhler disease requiring cast immobilization — supportive shoes alone are insufficient
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Self-limiting condition with excellent long-term prognosis in children
- Cast immobilization significantly shortens symptomatic phase
- No surgery required in virtually all pediatric cases
- Complete navicular reossification and normal architecture expected
❌ Cons / Risks
- 8-week cast immobilization limits activity significantly in young children
- Full radiographic reossification takes 1–2 years — parental patience needed
- Adult navicular AVN (Müller-Weiss) has completely different prognosis and requires different treatment
- Irregular navicular ossification in asymptomatic children may be misidentified as Köhler disease
Dr. Tom Biernacki’s Recommendation
Köhler disease is one of the few conditions in pediatric podiatry where I can give parents completely reassuring news: this will resolve, your child will not have long-term problems, and we have an effective treatment that shortens the painful phase. The cast is harder on parents than on the child in most cases — kids adapt remarkably well. The most important thing is not missing it in the first place. Any young child with a new limp, especially with in-toeing gait and medial midfoot tenderness, gets X-rays immediately in my office.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Is Köhler disease the same as Sever’s disease?
No — they are different pediatric osteochondroses affecting different bones and different age groups. Köhler disease is AVN of the navicular, affecting children ages 2–9 with midfoot pain and in-toeing limp. Sever’s disease (calcaneal apophysitis) is traction apophysitis at the heel’s growth plate, affecting children ages 8–14 with posterior heel pain during activity. Both are self-limiting, both respond to immobilization and orthotics, and both have excellent prognoses — but they are anatomically and clinically distinct conditions.
Does Köhler disease affect both feet?
Bilateral Köhler disease occurs in approximately 25% of affected children. When both feet are involved, symptoms may be sequential (one foot resolving as the other becomes painful) or simultaneous. Bilateral cases are managed the same as unilateral cases — each affected navicular is treated on its own clinical timeline. Bilateral presentation confirms the diagnosis with greater confidence, as bilateral navicular changes are rarely normal variants in symptomatic children.
What activities are safe during Köhler disease recovery?
During the cast phase: walking is permitted in the cast, but running and jumping sports are restricted. After cast removal and transition to orthotics: low-impact activities (swimming, cycling, walking on soft surfaces) are encouraged. High-impact sports (basketball, soccer, running) are gradually reintroduced as symptoms allow, typically at 3–6 months after cast removal. Dr. Biernacki provides sport-specific return-to-activity timelines based on the child’s symptom response and radiographic reossification progress.
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Foundation Wellness Orthotic Selector — PowerStep + CURREX by Condition (2026)
Find the right Foundation Wellness orthotic for YOUR specific condition. Dr. Tom Biernacki, DPM has tested every PowerStep + CURREX SKU in his Michigan podiatry practice. Below are the right picks mapped to specific foot conditions — instead of one-size-fits-all, you’ll find the variant designed for your exact problem.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
4.5
(28,341+ reviews)
Heavy-duty version of the Pinnacle with rigid shell + lateral wedge. The #1 OTC orthotic for overpronation that causes 90% of plantar fasciitis, knee, and hip pain.
- Rigid shell controls overpronation
- Lateral wedge corrects pronation
- Deep heel cradle
- Trim-to-fit any shoe
- Trim required
- 7-day break-in
My #1 prescription for flat-footed patients. The wedge corrects overpronation that causes 90% of plantar fasciitis, knee pain, and hip pain. Pair with stability shoe.
PowerStep PinnacleDr. Tom’s #1 Brand
4.4
(22,500+ reviews)
Flagship PowerStep — semi-rigid arch with deep heel cradle. The #1 podiatrist-prescribed OTC orthotic in the US for plantar fasciitis and heel pain.
- Semi-rigid medical-grade arch
- Deep heel cradle
- Dual-density EVA
- APMA-accepted
- 30-day guarantee
- Trim required
- Less aggressive than Maxx
My flagship prescription for plantar fasciitis. If you have heel pain — start here. 60% of patients see major improvement in 2 weeks.
PowerStep Pinnacle High ArchDr. Tom’s #1 Brand
4.5
(8,200+ reviews)
Higher-volume arch profile for cavus feet that don’t fill standard insoles. Prevents the lateral roll that causes ankle sprains in supinators.
- High-arch profile
- Deep heel cradle
- Prevents lateral roll
- Only for high arches
- Wrong choice for flat feet
Use the wet-foot test. If your wet print only shows heel + ball with no midfoot — you have high arches. This is your insole.
PowerStep Pinnacle Plus (with Built-In Met Pad)Dr. Tom’s #1 Brand
4.5
(5,800+ reviews)
Pinnacle with built-in metatarsal pad — eliminates the burning ball-of-foot pain from Morton’s neuroma + metatarsalgia.
- Built-in met pad — no separate pad needed
- Spreads metatarsal heads
- Same Pinnacle support
- Met pad position fixed
- Trim required
For ball-of-foot pain or numbness in toes — this insole is the fix. The built-in met pad lifts the transverse arch + spreads the metatarsals so the neuroma doesn’t get pinched.
PowerStep Morton’s Extension InsoleDr. Tom’s #1 Brand
4.5
(3,400+ reviews)
Stiffener under the 1st MTP joint — limits big toe extension. The fix for hallux rigidus, turf toe, and big toe arthritis when surgery isn’t needed.
- Stiffens 1st MTP joint
- Reduces big toe motion
- Prevents flare-ups
- Stiff feel takes 1 week
- Specific use case
For hallux rigidus or turf toe — stop the painful big toe motion. This insole replaces a $300 carbon plate at a fraction of the cost.
PowerStep ProTech Full LengthDr. Tom’s #1 Brand
4.4
(4,500+ reviews)
Premium athletic insole with carbon-reinforced shell + dual-density forefoot. Best PowerStep for serious athletes.
- Carbon-reinforced shell
- Dual-density forefoot
- Antimicrobial top
- Pricier
- Athletic use only
For athletes who push the standard Pinnacle to failure — the ProTech holds up to high-impact athletic use.
PowerStep Slim Profile (Dress Shoes)Dr. Tom’s #1 Brand
4.4
(6,200+ reviews)
Slim-profile Pinnacle that fits in dress shoes, work shoes, and low-volume footwear without lifting the heel out.
- Slim profile fits dress shoes
- Same Pinnacle arch
- Low-friction top
- Less cushion than full Pinnacle
- Trim required
For dress shoes, work shoes, or anything with a tight heel cup — this is your daily-wear insole.
PowerStep Wide (EE / EEE Fit)Dr. Tom’s #1 Brand
4.4
(3,800+ reviews)
Wider footbed for EE/EEE-width feet that overflow standard insoles. Same Pinnacle support, wider sole.
- Fits 2E/4E feet
- Same Pinnacle arch
- No spillover
- Won’t fit narrow shoes
- Pricier
If you wear 4E shoes — this is your only OTC orthotic option that won’t spill over the edges.
CURREX RunPro (3 Arch Heights)Dr. Tom’s #1 Brand
4.4
(4,000+ reviews)
German-engineered running insole with 3 arch heights (Low, Med, High) for custom fit. Carbon-reinforced heel — closest OTC orthotic to a $500 custom orthotic.
- 3 arch heights for custom fit
- Carbon-reinforced heel
- Dynamic forefoot zone
- Premium German engineering
- Pricier than PowerStep
- 7-10 day break-in
For runners — this is what professional athletes use. Choose your arch height from a wet-foot test.
CURREX WalkProDr. Tom’s #1 Brand
4.4
(1,800+ reviews)
Walking-specific CURREX — softer cushioning + lower-impact heel for daily walking and standing.
- Walking-specific cushioning
- 3 arch heights
- Premium materials
- Pricier
- Not for high-impact running
For 5+ miles of walking daily — this is more comfortable than RunPro. Choose your arch height first.
CURREX AceProDr. Tom’s #1 Brand
4.5
(1,400+ reviews)
Court-sport-specific CURREX — stiffer shell for lateral stability during quick stops + cuts. Pickleball + tennis + basketball.
- Lateral stability shell
- Quick-stop heel
- 3 arch heights
- Stiffer feel
- Sport-specific
Pickleball is exploding — if you play, this insole prevents the ankle sprains that 30% of new pickleball players get in their first year.
CURREX EdgeProDr. Tom’s #1 Brand
4.5
(1,200+ reviews)
Reinforced shank insole for ski + snowboard boots — prevents foot fatigue on steep descents.
- Reinforced shank
- 3 arch heights
- Cold-weather friendly
- Carbon plate
- Stiff feel
- Sport-specific
For skiers + snowboarders — this is the insole. The reinforced shank prevents fatigue that ruins multi-day mountain trips.
CURREX HikeProDr. Tom’s #1 Brand
4.5
(900+ reviews)
Hiking + backpacking insole — extra heel cushion + reinforced midfoot for uneven terrain.
- Extra heel cushion
- Reinforced midfoot
- 3 arch heights
- Bulky in low-volume shoes
- Pricier
For hikers + backpackers — replace your hiking boot insole with this. Prevents the foot fatigue that ruins long-distance hikes.
CURREX BikeProDr. Tom’s #1 Brand
4.5
(700+ reviews)
Cycling-specific insole — stiff carbon plate to maximize power transfer + cleat alignment.
- Stiff carbon plate
- Cleat-compatible
- Lightweight
- Cycling-only
- Pricier
For serious cyclists — this insole is what professional teams use. Power transfer up to 12% better than stock cycling shoe insoles.
Dr. Hoy’s Complete Pain Relief Line — Dr. Tom’s Picks (2026)
Dr. Hoy’s Natural Pain Relief is Dr. Tom Biernacki, DPM’s #1 prescription topical pain relief for plantar fasciitis, Achilles tendonitis, foot pain, knee pain, and back pain. Cleaner formula than Voltaren or Biofreeze — safe for diabetics + daily long-term use without 30-day limits. Below is the complete Dr. Hoy’s product line, organized by use case.
Dr. Hoy’s Natural Pain Relief Gel (4oz Tube)Dr. Tom’s #1 Brand
4.6
(5,500+ reviews)
The flagship Dr. Hoy’s — menthol-based natural pain relief gel. The bottle Dr. Tom hands every plantar fasciitis patient on visit one. Cleaner formula than Voltaren or Biofreeze.
- Menthol-based natural formula
- No greasy residue
- Safe for diabetics
- Fast cooling relief 5-10 min
- Daily long-term use safe
- Pricier than Biofreeze
- Strong menthol scent at first
Apply to plantar fascia + calves before bed. Combined with calf stretching, eliminates morning fascia pain. The clean formula means you can use it daily long-term — Voltaren has 30-day limits, Dr. Hoy’s doesn’t.
Dr. Hoy’s Natural Pain Relief Gel (8oz Pump Bottle)Dr. Tom’s #1 Brand
4.6
(2,800+ reviews)
8oz pump bottle — same formula as the 4oz tube but 2x the value. Best for athletes, families, or chronic pain patients who use it daily.
- 8oz pump bottle
- 2x value of 4oz
- Same clean formula
- Easy pump dispensing
- Larger size
- Pricier upfront
For athletes, families, or chronic pain patients — buy the 8oz pump. Twice the product at less than 2x the price.
Dr. Hoy’s Arnica Boost Pain ReliefDr. Tom’s #1 Brand
4.5
(1,800+ reviews)
Dr. Hoy’s + arnica boost — for bruising, swelling, post-injury inflammation. Adds arnica’s anti-inflammatory power to the standard menthol formula.
- Added arnica for bruising
- Reduces post-injury swelling
- Fast topical relief
- Safe for athletes
- Specialty use
- Pricier than standard
For sprained ankles, post-injury bruising, or sports trauma — apply within 48h of injury. The arnica reduces bruising depth + speeds recovery.
Dr. Hoy’s Natural Pain Relief Roll-OnDr. Tom’s #1 Brand
4.5
(2,200+ reviews)
Same Dr. Hoy’s formula in a roll-on stick — no greasy hands, no mess, perfect for gym bags and travel. TSA-friendly.
- No greasy hands
- TSA-friendly
- Travel-sized
- Same Dr. Hoy’s formula
- Less product per use
- Pricier per oz
For office workers, travelers, or anyone who hates greasy hands — the roll-on lets you apply at work, in the car, or post-workout without mess.
Dr. Hoy’s Pain Relief Gel — 3-Pack BundleDr. Tom’s #1 Brand
4.6
(650+ reviews)
3-pack of Dr. Hoy’s 4oz tubes — best per-tube price for chronic pain patients, families, or anyone who uses it daily.
- 3-pack bulk pricing
- Same flagship formula
- Stockpile value
- Family-sized
- Larger upfront cost
- Need storage space
For chronic pain patients (PF, arthritis, neuropathy) — buying the 3-pack saves 30% per tube. One tube usually lasts 3-4 weeks of daily use.
Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)
If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed for 30+ days minimum. Last verified: April 28, 2026.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
4.5
(28,341+ reviews)
Dr. Tom’s most-prescribed OTC orthotic. Lateral wedge corrects overpronation that causes 90% of foot pain. Deep heel cradle stabilizes the ankle. Built by podiatrists, used by patients worldwide.
- Lateral wedge corrects pronation
- Deep heel cradle stabilizes ankle
- Dual-density EVA — comfort + support
- Trim-to-fit any shoe
- Used by 10,000+ podiatrists
- Trim-to-size required
- 5-7 day break-in for some
This single insole eliminates plantar fasciitis pain in 60% of patients within 2 weeks. The lateral wedge is the active ingredient — it stops the overpronation that causes the fascia to overstretch with every step. Pair with a max-cushion shoe for compound effect.
CURREX RunProDr. Tom’s #1 Brand
4.4
(4,000+ reviews)
3 arch heights for custom fit (Low/Med/High). Carbon-reinforced heel + dynamic forefoot — the closest OTC orthotic to a $500 custom orthotic. Engineered in Germany.
- 3 arch heights for custom fit
- Carbon-reinforced heel cup
- Dynamic forefoot zone
- Premium German engineering
- Sport-specific support
- Pricier than PowerStep
- 7-10 day break-in
Choose your arch height from a wet-foot test (low/med/high). Wrong arch = re-injury. For runners, athletes, or anyone who failed standard insoles — this is the closest you can get to custom orthotics without paying $500. The carbon heel is what professional athletes use.
Dr. Hoy’s Natural Pain Relief GelDr. Tom’s #1 Brand
4.6
(5,500+ reviews)
Menthol-based natural pain relief — Dr. Tom’s #1 brand for fast relief without greasy residue. Safe for diabetics + daily use. Cleaner formula than Voltaren or Biofreeze.
- Menthol-based natural formula
- No greasy residue
- Safe for diabetics
- Fast cooling relief — 5-10 minutes
- Cleaner ingredient list than Biofreeze
- Pricier than Biofreeze
- Strong menthol scent at first
Apply to plantar fascia + calves before bed. Combined with stretching, eliminates morning fascia pain. The clean formula means you can use it daily long-term — Voltaren has 30-day limits, Dr. Hoy’s doesn’t.
Frequently Asked Questions
What causes this condition?
Causes include mechanical stress, biomechanical imbalance, age-related changes, and sometimes systemic disease. Our clinical exam plus imaging identifies the specific driver.
Can it go away on its own?
Mild cases sometimes resolve with rest and supportive footwear. Persistent symptoms past 4-6 weeks rarely resolve without active treatment.
Is surgery required?
Most patients resolve with non-surgical care. Surgery is reserved for refractory cases or structural deformity.
Visit Balance Foot & Ankle — Same-Day Appointments Available
Our podiatry team serves patients throughout Michigan including Howell, Brighton, and Bloomfield Hills. Whether you’re dealing with heel pain, ingrown toenails, or a foot injury, we have same-day appointment availability.
American Academy of Orthopaedic Surgeons: Köhler Disease
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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.