Kohler Disease

In 1908 Kohler first described the disease named in his honor.This clinical entity belongs to a group of diseases called osteochondritis. Recognized in the literature are about 40 different osteochondritis. Under these conditions self-limiting disease process is avascular necrosis of the primary or secondary centers of ossification. Almost all epiphyses, apophyses and small bones can be affected. The etiology is not well known condition, but stroke, coagulation abnormalities and heredity are involved.Osteocondritele most frequent disease Legg-Calve-Perthes, Osgood-Schlatter, Frieberg and Panner.
Kohler disease is a rare pathological condition of the plant child between 6 and 9 years old. The temporary loss of blood supply caused by navicular bone. After treatment does not cause long term health problems. As symptoms disappear navicularul returns to normal.
Patients experience pain and swelling in the middle of the plant and usually flaccid member or unusable as a result. The disease affects mainly boys. It uses an X-ray to diagnose. Affected plants navicular bone shows a dense and domed.The patient will wear a cast up above the knee. Moderate exercise is recommended. Perisista disease rarely more than 2 years of evolution. Rest, NSAIDs administration are important. The disease usually resolves without treatment and no long term consequences.
Pathogenesis and causes
As in other osteochondritis, Kohler etiology is unknown. It acknowledges the involvement of a vascular event. Navicularului vasculature develops in two ways and is identical in adults and children. A branch of the dorsal artery crosses the dorsal pedia navicularului and give 3-4 small arteries. Some come from small arteries medial plantar artery to supply the plantar face. These blood vessels form a dense network around the pericondru penetrate bone and cartilage to the center.
Kohler suggested that changes in this disease may be the result of abnormal pressure forces acting on naviculei weak. Among the theories that explain the nature of the lesion is the most satisfying mechanics associated with late ossification. Navicula Tarsal which is the last bone to ossify kids. It can be compressed between the already ossified talus and cuneiform when children gain weight.Compression involves the vessels of the central spongy bone leading to ischemia and clinical symptoms. This ring pericondral vessels allowing blood to send small branches revascularization and new bone formation.
Signs and symptoms
Kohler disease is rare. The disease begins after age 2 years, but is most common in children 5-10 years. It is more common in boys than girls. This phenomenon is probably due to the development of ossification centers from 18-24 months 24-30 months girls against boys.It is an unusual condition in which children show a flaccid member local analgesic and sensitivity of the plant above the medial face navicularului. The child may go down on the side of the foot. Often there is swelling and redness in the adjacent soft tissue.
Diagnosis
Imaging Studies:Plant radiograph shows:Scaphoid-lateral flattening of the derivation-Space between the talus and cuneiform is not diminished-Often there is an irregular ossification navicularului or radiological changes are similar to Kohler's disease.Bone scintigraphy scan shows diminished radionuclide uptake in the mediotarsala. The exam is not necessary for diagnosis.If pain persists for six months after ghipsaj recommend an investigation of magnetic resonance imaging or computed tomography to exclude tarsal fusion.
Treatment
It is recommended to wear a cast for a limited defense of the plant.Gypsum is the duration of 6-8 weeks. It will be modeled in moderate varus and equinus. In this position navicula is relaxed. It is recommended ghipsaj Cirja after 6-month period of use. In mild cases may be the only therapeutic method crutches.Symptoms may persist in these patients under 3 months. In untreated patients, symptoms may be present for 15 months.Symptom duration of immobilization in a cast decreases. If pain is persistent for at least six weeks ghipsaj will apply a new cast for another 6 weeks.Evolution of the radiographic appearance of the plant investigation in Kohler's disease is variable. Radiograph may be normal in 6-18 months after onset. At the age of navicular bone adult must be normal. Patients planting function recovers completely.