Bilateral Köhler's disease in identical twins

Köhler's disease is an uncommon idiopathic osteochondrosis of the tarsal navicular bone. The diagnosis is clinical and the natural history is benign. The treatment is symptomatic, including shoe supports when the symptoms are mild and initial cast immobilization for at least 8 weeks when the symptoms are more intense. The final clinical outcome is always favorable. This article reviews the development of bilateral Köhler's disease in identical twin brothers with simultaneous onset and parallel clinical course. Bilateral involvement in identical twins, to the authors' knowledge, has not been reported in the literature. Although this is a preliminary finding, it can imply that an unknown genetic predilection may exist and relate to the appearance of this rare disease.