Elevated BMI as a Key Risk Factor in Pediatric Osteochondroses: A Dual Case Report of Köhler Disease and Haglund–Sever Disease

Abstract

Background:

Avascular necrosis in childhood encompasses a group of osteochondroses in which impaired microcirculation and repetitive mechanical overload compromise the integrity of developing bone. Köhler disease and Haglund–Sever disease represent two distinct anatomical manifestations of this process. Despite differing locations, both conditions share a common pathophysiological mechanism involving hypoperfusion of immature bone exposed to excessive compressive or traction forces. Early recognition is essential to prevent long-term deformity and ensure full functional recovery.

Case presentation:We report two cases of non-traumatic foot pain in pediatric patients. Patient 1: A 5-year-old boy presented with acute medial midfoot pain and limping, without preceding injury. Radiographs revealed navicular flattening, sclerosis, and demineralization, confirming Köhler disease. A short-leg cast for six weeks and NSAIDs for symptom relief resulted in gradual improvement.

Patient 2: A 7-year-old boy reported intermittent heel pain worsening with physical activity. Imaging demonstrated radiographic features of Haglund–Sever disease. Management included temporary cessation of sports, an orthopedic heel insert, targeted stretching, physiotherapy to enhance local circulation, and nonsteroidal anti-inflammatory drugs (NSAIDs) as needed. Both patients had BMI above the age-appropriate range, suggesting mechanical overload as a relevant contributing factor.

Conclusion:These cases illustrate that Köhler disease and Haglund–Sever disease, though anatomically distinct, conform to a unified model of pediatric osteochondrosis driven by mechanical stress and disrupted microvascular supply. Standard radiography remains the principal diagnostic tool, while laboratory testing provides limited additional value. Prompt diagnosis and conservative, load-reducing therapy result in complete symptom resolution and prevent structural complications.