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A child with Kohlerâs disease may present similarly to a child with a foot injury. An examination will reveal pain and tenderness over the dorsomedial midfoot, with or without local skin changes. Affected children typically walk with a limp or antalgic gait, with weight bearing on the lateral side of the foot.
More than one-half of cases of acute hematogenous osteomyelitis in children occur in patients younger than five years.7 Children typically present within two weeks of disease onset with systemic symptoms, including fever and irritability, as well as local erythema, swelling, and tenderness over the involved bone.8 Chronic osteomyelitis in children is uncommon.9