Köhler’s disease I and II

Introduction

Two very similar diseases are summarized as Morbus Köhler. Köhler’s disease I is the dying off of the scaphoid at the foot. The scaphoid is a tarsal bone.

In contrast, Köhler’s disease II is the dying off of the metatarsal bone, typically that of the second, third or fourth ray. In both forms of Köhler’s disease, this dying off occurs spontaneously, i.e. without external influence and without infection. Köhler’s disease I is a disease that primarily affects children between the ages of eight and twelve, with boys being affected much more frequently than girls.

Children around the age of ten are also affected by Köhler’s disease II, but girls are more likely to be affected. Since Köhler II disease usually causes symptoms only in a late stage of the disease, the disease is often only recognized in adulthood. The exact origin of Köhler’s disease is still unknown, but a number of models of its development are being discussed.

On the one hand, it is striking that Köhler’s disease occurs at the age of the beginning of puberty, i.e. 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 thus an instability of the bone develops. Another theory points to similar diseases that are usually associated with reduced blood flow to the bone.

This theory is supported by the fact that this mechanism has been proven in other diseases. What speaks against this theory, however, is that the reduced blood circulation in similar diseases does not occur until middle adulthood and is then usually accompanied by considerable stress on the bone with vibrations. For children, this mechanism would be rather unusual. Another theory also suspects an overloading of the bone, which certainly plays a role. However, why some children fall ill and others do not, cannot be sufficiently explained.