Köhler's disease I and II

introduction

Two very similar diseases are summarized as Köhler's disease. As Köhler's disease I, a death of the Scaphoid at the foot designated. The scaphoid is a Tarsus.
Köhler's disease, on the other hand, refers to the death of Metatarsal bones, typically des second, third or fourth Beam.

This death occurs in both forms of Köhler's disease spontaneous on, that is, without external influence and without infection. Köhler's disease is a disease that mainly affects children between the ages of eight and twelve, with boys falling ill more often than girls.
Children around the age of ten also suffer from Köhler's disease, but girls are more likely to be affected. Since Köhler's disease usually only causes symptoms in a late stage of the disease, the disease is often only recognized in adulthood.

Disease emergence

The exact origin of Köhler's disease is still unknown, but a number of models are being discussed. On the one hand, it is noticeable that Koehler's disease is beginning in the age puberty, i.e. occurs during a growth spurt.
Therefore, it can be assumed that the normally occurring increasing ossification of the skeleton cannot keep up with the growth and this creates instability of the bone.

Another theory points to similar diseases, usually with one decreased blood flow of the bone go hand in hand. This theory is supported by the fact that this mechanism has been proven in other diseases. Against this theory, however, speaks that the reduced blood flow in similar diseases only in middle adulthood occur and are then usually associated with considerable stress on the bone with vibrations. This mechanism of development would be rather unusual for children.

Another theory also suggests overloading the bone, which certainly plays a role. But why some children get sick and others do not cannot be adequately explained.

complaints

Typically, a child with Köhler's disease fails first Pain on exercise of the affected foot, being no external injury present.In addition, pain occurs when pressure is applied to the navicular bone.

There are a total of four scaphoid bones on the body, namely on each foot and each hand one at a time. The foot is affected in Köhler's disease, it is also known medically as "Navicular bone" designated. This scaphoid bone is at the foot of the transition to Ankle joint on the big toe side, i.e. inside.
Most often there is also swelling.

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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
Therefore, the treatment of the foot (e.g. Achilles tendonitis, heel spurs, etc.) requires a lot of experience.
I focus on a wide variety of foot diseases.
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Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Diagnosis

If Köhler's disease is suspected, this suspicion must be confirmed. This is usually done using a X-ray image. The affected foot is X-rayed once from above and once from the side.
With Köhler's disease I usually see a clear one Compression and narrowing of the affected scaphoid bone in the X-ray. Sometimes it's postponed.
In the case of Köhler's disease II, an X-ray is also taken, but with a focus on the Metatarsus. As a rule, you can see a shortening and flattening of the affected metatarsal at its distal end. In the further course of the disease, changes in the metatarsophalangeal joint can also be seen, which of course also leads to pain. This is also important for further therapy, since damage to the joint must also be treated in order to prevent permanent damage.

therapy

When treating Koehler's disease, there is one first Protection of the foot in the foreground. First one has to Sports break lasting several weeks must be complied with to the bone to give a chance at healing. Then both forms of Köhler's disease orthopedic shoe insoles recommended to support the arch of the foot. If there is no improvement, it may be necessary, especially with Köhler's disease I, to keep the foot on for about a month with a Plaster splint immobilize.
With Koehler II disease, it may also be necessary to take pain relievers, especially in adult patients. This would typically be the case Ibuprofen or Paracetamol grab, especially when taking a stomach protector (Pantoprazole) as these pain relievers tend to take the Gastric mucosa to attack.

Is that too Joint space Affected and inflamed, the same can be said of Köhler's disease II cortisone Inject into the joint space to reduce the inflammatory reaction.
A trial is also made Shock wave therapy used to supply blood to the dying bone again. With Koehler II disease, one can also surgery become necessary. However, this is only necessary if the previous measures have not led to success. During an operation, the dead bone is removed. The affected metatarsal bone can possibly also be shortened in order to take the strain off the joint space.

forecast

Köhler's disease I has a very good prognosis, even if the healing process can take a long time, over several years. An operation is practically never necessary and the damage usually heals without consequences.

It looks different with Köhler's disease II. On the one hand, this is due to the fact that the disease is recognized late. Then an operation can often no longer be avoided. The damage often does not heal back to its original state, so that slight complaints can remain, and possibly even one Stiffening of the sole of the foot may be necessary.