Summary about Disease
Köhler disease is a rare bone disorder that affects the navicular bone (a bone on the inner side of the foot) in children, typically between the ages of 2 and 10. It occurs when the blood supply to the navicular bone is temporarily interrupted, causing the bone to shrink and harden. This process is called avascular necrosis. It is usually unilateral (affecting only one foot).
Symptoms
Pain and tenderness in the midfoot, especially along the inside arch.
Limping.
Swelling and redness in the affected area.
Difficulty walking or bearing weight on the foot.
Reduced range of motion in the foot.
Pain that worsens with activity and improves with rest.
Causes
The exact cause is unknown. However, it's believed that Köhler disease results from a temporary disruption of blood flow to the navicular bone during a period of rapid growth. Potential contributing factors may include:
Increased stress on the foot bones from activities like running and jumping.
Anatomical variations that make the navicular bone more vulnerable.
Coagulation disorders that could affect blood supply.
Medicine Used
There is no specific medication to cure Köhler disease. Treatment focuses on managing symptoms and supporting the healing process. Pain relief is achieved through:
Pain relievers: Over-the-counter medications like ibuprofen or acetaminophen. Stronger pain relievers are rarely needed.
Anti-inflammatory medications: In some cases, nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce inflammation and pain.
Is Communicable
Köhler disease is not communicable. It is not caused by an infection and cannot be spread from person to person.
Precautions
Rest: Avoiding activities that put stress on the foot.
Immobilization: Wearing a cast or walking boot to protect the navicular bone.
Orthotics: Using arch supports to help distribute weight more evenly.
Physical therapy: Performing exercises to improve range of motion and strength.
Proper footwear: Wearing supportive shoes.
How long does an outbreak last?
The duration of Köhler disease varies but typically lasts from 6 months to 2 years. It usually resolves spontaneously as the blood supply to the navicular bone returns and the bone heals.
How is it diagnosed?
Diagnosis typically involves:
Physical examination: A doctor will examine the foot for pain, swelling, and limited range of motion.
X-rays: X-rays of the foot are the primary diagnostic tool. They can reveal changes in the shape and density of the navicular bone.
MRI or Bone Scan: In some cases, an MRI or bone scan may be used to further evaluate the blood supply to the navicular bone and rule out other conditions.
Timeline of Symptoms
The timeline can vary but generally follows this pattern:
Initial Phase: Gradual onset of pain in the midfoot, often worsening with activity. Limping may develop.
Progression: Pain becomes more constant and may be accompanied by swelling and tenderness.
Plateau: Symptoms may remain relatively stable for a period of time.
Resolution: Pain gradually decreases as the navicular bone begins to heal and regain its normal shape. Function slowly returns.
Important Considerations
Early diagnosis and treatment can help minimize symptoms and prevent complications.
Adherence to the treatment plan is crucial for successful healing.
Although rare, long-term complications, such as chronic pain or arthritis, can occur in some cases.
Regular follow-up with a doctor is important to monitor progress and adjust treatment as needed.