Köhler I disease is a very rare, aseptic necrosis of the navicular bone. Köhler I disease occurs predominantly in boys between the ages of three and eight years. However, many physicians only make the diagnosis later in life; in many cases, arthrosis has already formed in the tarsus.
What is Koehler I disease?
First there is Morbus Köhler I and Morbus Köhler II ; While Köhler I disease is a necrosis of the navicular bone, a tarsal bone, the metatarsal bones (second, third or fourth ray) die off in Köhler II disease. See homethodology for Keratoderma Overview.
Characteristic of Köhler I disease is spontaneous death or the spontaneous formation of necrosis. This means that neither an infection nor any other external influence is responsible for the necrosis occurring.
So far it is unclear what caused the death. The disease becomes noticeable through pain in the foot without anything being visible on the outside.
The doctor can make a diagnosis using x-rays.
Causes
The reasons for Köhler I disease have not yet been clarified. However, many experts have been discussing possible development models for years or are of the opinion that they have found favorable factors that could cause Köhler I disease. It is striking that Morbus Köhler I always occurs when the affected person has a so-called growth spurt.
For this reason, the assumption of the physicians suggests that the ossification of the skeleton sometimes has problems and cannot keep up with the growth. For this reason, bone instability develops in the affected region.
Another theory is based on similar diseases, which are sometimes characterized by a circulatory disorder. However, the fact that reduced blood flow only occurs in old age or adulthood speaks against this assumption, so that this factor is not present in the context of Köhler’s disease I.
Furthermore, doctors are of the opinion that overloading of the bone can also be the decisive reason for Morbus Köhler I. However, the reason why only children and especially boys get sick could not be answered within the framework of that theory.
Symptoms, Ailments & Signs
A first sign is pain. The person concerned complains of sudden pain during exertion (e.g. when walking or running). However, external injuries or changes in the foot cannot be detected.
Patients also complain of pain when pressure is applied to the scaphoid. If the foot is not rested, swelling can occur in the region of the navicular bone, which also suggests that it could be Köhler I disease.
Diagnosis & course of disease
If there is a suspicion that it is Köhler I disease, the diagnosis must be confirmed – in addition to the so-called suspected diagnosis. The diagnosis is confirmed by means of an X-ray. The affected foot is X-rayed from the side and from above. If Köhler I disease is actually present, the doctor can see a narrowing and at the same time a compression of the scaphoid.
Sometimes it can already be displaced, which is another indication that there is a high probability of Köhler I disease. Other examinations are not necessary. However, within the context of confirming the diagnosis, the doctor must ensure that he can definitely rule out Köhler II disease.
Köhler I disease has a relatively good prognosis. While the healing process is lengthy and takes several years, it shows promise. Mostly the doctor decides for a conservative therapy; Operations are only necessary in the rarest of cases. Damage caused by Morbus Köhler I usually heals – without long-term consequences.
Complications
Due to Köhler I disease, the patient primarily experiences very severe pain. This pain occurs primarily during stress and can thus significantly restrict the patient’s everyday life. As a rule, patients suffer from pain primarily when walking or running, although it is not uncommon for this to also occur in the form of rest pain.
Pain at rest at night can lead to sleep disorders and possibly to depression. Likewise, no injuries or other peculiarities can be discovered from the outside. It is not uncommon for Köhler I disease to lead to severe swelling in the affected regions. This can occur if the legs continue to be strained even when there is pain.
As a rule, the quality of life of those affected is significantly reduced by this disease. The patient’s everyday life is also restricted, so that physically demanding activities or sports can no longer be carried out. Especially in children, Köhler I disease can therefore lead to developmental restrictions.
Treatment of the disease does not lead to further complications. Physiotherapy measures in particular are necessary to alleviate the symptoms. However, a completely positive course of the disease cannot be guaranteed in every case.
When should you go to the doctor?
The risk group for Köhler I disease consists of boys between the ages of three and eight. Although the correct diagnosis is often only made a few years after the first signs of a health irregularity, a doctor’s visit should be made as soon as the first symptoms appear. If the children complain of pain in the bones or when moving, a doctor should be consulted to clarify the symptoms. There is a risk of confusion with the natural growing pains. For this reason, it is particularly important to have a careful investigation initiated as soon as a discrepancy is suspected in direct comparison to children of the same age.
If the child is particularly tearful or supposedly self-pitying, a check-up visit with a doctor is necessary. If there are any peculiarities in the movement sequences or general motor skills, a doctor is needed. A reduced level of physical performance, premature exhaustion or low resilience of the child must be examined and clarified. If you notice bone instability, limping or signs of a circulatory disorder, you need to see a doctor. A particularly pale skin in the affected region or cold feet can indicate a health impairment. If they continue unabated over a longer period of time, it is advisable to consult a doctor.
Treatment & Therapy
If the physician diagnoses Morbus Köhler I, various therapy options are available to him. Doctors usually opt for conservative treatment. The leg should therefore often be rested; Deposits can provide relief. Sometimes the leg can also be immobilized – by sending a plaster cast. Physiotherapeutic treatments are particularly important.
This is because any tension, muscle hardening or other stiffening can be prevented. Massages or targeted therapies that deal with the relaxation and movement of the foot help to ensure that the course of the disease can be shaped positively and that no long-term effects are to be expected at the end of the healing process.
With hyperbaric oxygen therapy, the medical professional can regulate the ambient pressure for the patient – using the hyperbaric chamber – and deliver 100 percent oxygen. Records have shown that patients who were diagnosed with Köhler I disease in the early stages were able to benefit from the treatment.
Hyperbaric oxygen therapy is also often used as part of physiotherapeutic treatment and is one of the conservative treatment methods. Surgeries are rarely necessary, but necessary if conservative treatments do not bring the desired success or if Köhler I disease could only be diagnosed at a later stage.
The doctor tries to stiffen the joint ; that variant is then ready for a decision when advanced arthrosis has already developed, which causes enormous pain to the patient. However, there are also surgical measures that can be taken at the beginning of Köhler I disease.
The physician decides to use the so-called Pridie bore. This means that the doctor drills into the affected bone and thus initiates revascularization. This method is rarely used, and if it is, then only in the early stages of Köhler I disease.
Outlook & Forecast
Morbus Köhler I can usually be successfully treated. Scientifically based treatments are available that allow the symptoms to be completely eliminated. However, the healing process can take a long time. The treatment spectrum ranges from months to years. It is recognized that early treatment initiation yields the best results. On the other hand, those who do not undergo treatment or do not attach importance to typical symptoms run the risk of osteoarthritis in adulthood. This results in instabilities and movement restrictions that put a heavy strain on everyday life.
The disease is mostly diagnosed in male children. The body is still growing at this age. Relief of the metatarsal and other conservative procedures are usually sufficient to achieve complete healing. During this time, the body has tremendous self-healing power, which means that an operation is not necessary.
This results in a favorable prognosis for Morbus Köhler I. If symptoms persist in rare cases, they can be almost completely eliminated with aids. Those affected do not have to suffer any significant restrictions in their quality of life. Köhler I disease does not shorten lifespan.
Prevention
Preventive measures are not known, as no causes have been found so far why Morbus Köhler I develops.
Aftercare
In many cases, the measures and options for direct follow-up care for Köhler I disease are significantly limited. Sometimes it is not even available to those affected due to the severity of the disease. For this reason, patients should ideally consult a doctor very early on and also initiate treatment so that no further symptoms and complications can occur.
Self-healing is also not possible, so treatment by a doctor is always necessary. Due to the genetic origin of Morbus Köhler I, those affected should have a genetic examination and counseling carried out if they wish to have children in order to prevent the disease from recurring in their descendants. In most cases, patients with the disease are dependent on physiotherapy and physiotherapy to relieve the symptoms.
Many of the exercises from such therapies can be repeated at home, which speeds up the treatment. The support of one’s own family in the everyday life of the person concerned is also often very important. Depression and other mental upsets can also be prevented. The disease Morbus Köhler I usually does not reduce the life expectancy of the patient.
You can do that yourself
In the case of the disease, the person affected has little scope and options for self-help. In everyday life, the physical limits should be perceived and observed. Especially during the growth spurt, a sudden decrease in physical performance can occur, which must be taken into account. In the case of pain and discomfort, the organism should be protected. Sufficient rest periods must be observed so that the forces can be regenerated.
The footwear is to be adapted to the size of the foot. It should be neither too small nor too big. Wearing high heels should be avoided throughout the child’s growth and development period, as this can increase symptoms. Sturdy footwear, the size of which is checked and adjusted at regular intervals, is important and necessary. The patient’s body weight should be within the normal range for BMI. Being overweight should be avoided as this has a negative impact on the development of bone structure and joints. It can lead to postural damage or complaints that cause an impairment of well-being.
If there is pain at rest or a persistent pain experience, a doctor should be consulted, as medical care is required. Competitive sports or the practice of extreme sports are not permitted. They represent an additional burden that has a negative effect on the course of the disease.
