Complaints
Typically, a child with Köhler’s disease is first noticed by pain when the affected foot is strained, whereby there is no external injury. Pain also occurs when pressure is applied to the scaphoid. There are a total of four scaphoids on the body, one on each foot and hand.
In Köhler’s disease, the foot is affected and is medically known as “Os naviculare”. This scaphoid is located on the inside of the foot at the transition to the ankle joint on the side of the big toe. Mostly swellings also occur.
Diagnostics
If Köhler’s disease is suspected, this suspicion must be substantiated. This is usually done with the help of an X-ray image. The affected foot is x-rayed once from above and once from the side.
In the case of Köhler’s disease I, the affected scaphoid is usually clearly thickened and narrowed in the X-ray image. Sometimes it is already displaced. In the case of Köhler II disease, an x-ray is also taken, but with the focus on the metatarsus.
In this case, one usually sees a shortening and flattening of the affected metatarsal bone at its distal end. As the disease progresses, changes in the metatarsophalangeal joint of the toe can also be seen, which naturally leads to pain. This is also important for the further therapy, as damage to the joint must also be treated to prevent permanent damage.
In the treatment of Köhler’s disease, the first priority is to protect the foot. First, a sports break of several weeks must be observed to give the bone a chance to heal. Then orthopedic insoles are recommended for both forms of Köhler’s disease to support the arch of the foot.
If there is no improvement, it may be necessary to immobilize the foot with a plaster splint for about one month, especially in the case of Köhler’s disease I. In the case of Köhler II disease, it may also be necessary to take painkillers, especially in adult patients. In this case, one would typically take ibuprofen or paracetamol, although one should also take a stomach protector (pantoprazole), especially if taken over a longer period of time, as these painkillers tend to attack the stomach lining.
If the joint space is also affected and inflamed, cortisone can also be injected into the joint space in the case of Köhler II disease in order to reduce the inflammatory reaction. As an experiment, shock wave therapy is also being used to restore blood flow to the dying bone. In the case of Köhler II disease, surgery may also be necessary. However, this is only necessary if the previous measures have not been successful.During an operation, the dead bone is removed. It may also be possible to shorten the affected metatarsal bone in order to reduce the load on the joint space.
