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Keller's osteochondropathy
Last reviewed: 23.04.2024
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One type of aseptic necrosis is Keller disease. It occurs in two forms, affects the bones of the foot and is age-related. Most often occurs in children and adolescents.
Causes of the osteochondropathy
The main causes of death of cancellous bone tissue are associated with persistent disruption of its blood supply:
- Regular trauma to the foot.
- Endocrine diseases and metabolic disorders: diabetes mellitus, thyroid lesions, obesity.
- Wearing cramped or not sized shoes.
- Congenital, acquired defects of the arch of the foot.
- Genetic predisposition.
With Keller's osteochondropathy, there is an insufficient supply of bone tissue with oxygen and other beneficial substances. Because of this, degenerative processes begin, bone structures die off and aseptic necrosis develops.
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Symptoms of the osteochondropathy
The pathological condition occurs in two forms:
- Keller's disease I
Characterized by scaphoid changes. Most common in boys 3-7 years. Manifested by edema near the inner edge of the back of the foot. Palpation and walking causes discomfort. The patient begins to limp, as the entire load is transferred to a healthy foot.
Constant pain leads to the progression of pathology. The inflammatory process is absent. The disease does not spread to the second leg. The duration of this form is about a year, after which the painful symptoms completely disappear.
- Keller's Disease II
Has a bilateral nature, causes damage to the heads II and III of the metatarsal bones of the feet. The onset of the pathological process proceeds with mild pain at the base of the 2 and 3 toes. The discomfort is aggravated by palpation, walking and another load on the toes, but at rest, the pain subsides.
As the progression of the pain becomes strong and constant, without stopping even at rest. Visually, there is a limitation of movement in the joints of the fingers and a shortening of the phalanges. This form is bilateral. Lasts about 2-3 years.
The destruction and slow restoration of cancellous bone proceeds in stages with such pathological changes:
- Aseptic necrosis - bone beams are dying, that is, one of the bone structures. Bone density decreases, so it does not withstand the previous load.
- Compression fracture - new but not strong beams are formed, which under normal loads burst and wedged into each other.
- Fragmentation - osteoclasts dissolve fractured and dead sections of bone beams.
- Reparation - the gradual restoration of the structure and shape of the bone. Full regeneration is possible while ensuring normal blood supply to the affected bone area.
The symptomatology of all forms of the disease adversely affects the patient's physical activity. Soreness and swelling of the foot cause a change in gait, lameness, inability to move and run quickly. The pathological condition is complicated by regular micro-fractures in the affected area.
Treatment of the osteochondropathy
The treatment is the same for both types of pathology and consists of a complex of such measures:
- Immobilization of the affected limb with a plaster cast for 1 month or longer.
- Drug therapy - non-narcotic analgesics for the relief of pain. Preparations for improving peripheral blood circulation and activation of calcium metabolism, vitamin-mineral complexes.
- Physical therapy - after the removal of the gypsum, the patient is prescribed a foot massage, foot baths, electrophoresis, mud therapy, magnetic therapy.
- Physiotherapy complex - the doctor selects special exercises that allow you to develop a foot after prolonged immobilization and restore its functionality.
- Surgical treatment - revascularization osteoperforation is performed as an operation, that is, holes are created in the bone to improve arterial blood flow. Due to this, the tissue of the blood supply to bypass the affected vessels.
Prevention
Special attention is paid to preventive measures. To prevent Keller's disease, you need to choose the right shoes with an orthopedic insole. You should also avoid increased physical activity for children of preschool age. For any injuries or painful symptoms, consult a physician.