Keller's disease 1 µb 10. Keller's disease. Causes of Kohler's disease

Keller's disease is a disease that affects the joints of the foot. Received ICD code M92. When bones are affected, it manifests itself as aseptic necrosis, due to which the tissue of the spongy bone dies.

In place of the dead area, connective and then bone tissue is formed. The disease is generally benign, but precisely because of the deformation it can even lead to disability. This disease is divided into two types:

• Pathological lesion of the scaphoid bone;
• Damage to the heads of the 2nd and 3rd metatarsal bones.

In general, the process and mechanism of development of the disease is the same for both types. At the same time, depending on whether high-quality and timely treatment is carried out, the outcome of the disease will depend.

The photo shows the localization of Keller's disease types 1 and 2

Causes of pathology

Doctors and scientists still do not know the exact reasons that provoke Keller's disease.

• congenital features of blood circulation in the feet;
• wearing tight shoes;
• various foot injuries;
• acquired defects, for example flat feet (transverse, longitudinal);
• poor vascular condition due to diabetes;
• endocrine and metabolic disorders (obesity, hypothyroidism (this is a lack of thyroid hormones)).

A favorable factor may be a hereditary predisposition or arthritis in the child.

Symptoms of Keller's disease 1

This type of disease manifests itself as swelling closer to the inner edge of the dorsum of the foot, caused by swelling of the tissues of this area. On palpation, the affected area is painful, and pain is also felt when walking or other stress on the foot. The child quickly gets tired of walking, stops running, and complains of pain in his leg. Parents may notice that he tries to lean on the outer edge of the sore foot, which is why his gait suffers.

The pain becomes permanent as the process progresses. Their intensity increases, they do not go away even at rest after a long rest.

There are no symptoms of inflammation, such as local fever and redness of the skin.

Type 1 Keller disease usually affects only one foot and does not spread to the other.

The duration of this type of disease reaches up to a year, ending with the complete disappearance of symptoms or persistent deformation of the scaphoid bone.

This form of pathology is most often bilateral. The beginning of the process goes unnoticed. The development of bone degeneration is indicated by the occurrence of mild painful sensations at the base of the 2nd and 3rd toes. Pain intensifies with palpation of the affected area and stress on the toes; it subsides with rest.

Gradually, the nature and intensity of the pain changes, it becomes constant and strong, and does not stop at rest.

Upon examination, the doctor notes limited movement in the joints of the phalanges of the fingers formed by the metatarsal bones, as well as shortening of the fingers, at the base of which necrosis of the tubular bone tissue has occurred.

Unlike the first type, Keller disease 2 lasts 2–3 times longer, lasting an average of 2–3 years. There are cases of familial damage to the bones of the feet.

The symptoms of the disease do not appear immediately, and therefore many people ignore them. Basically, the manifestations look like this in the first type of disease:

• in the foot;
• Quite severe pain in the affected area, that is
• Increased pain on palpation;
• Swelling closer to the inside of the foot;
• Change in gait - the child tries to rely on the outer part of the foot;
• Complaints of pain, fatigue.

With the second type of Keller's disease, the following symptoms appear:

• Minor pain in the area of ​​the 2nd and 3rd toes;
• Increasing pain with tactile contact and stress;
• Swelling in the area of ​​the 2nd and 3rd metatarsal bones;
• Restricted mobility in the phalanges of the fingers, inability to stand on tiptoes.

It is noteworthy that initially quite mild pain gradually increases over time, which leads to the manifestation of the symptom more often and longer. Over time, it becomes almost constant.

Stages

If we talk about stages, the following are distinguished:

1. Aseptic necrosis, which develops due to circulatory disorders;
2. A compression fracture develops when the affected joint is loaded;
3. The affected area is fragmented;
4. Gradually, tissues susceptible to necrosis are resorbed;
5. Tissue restoration occurs with some shortening of the joints.

These stages last for quite a long time - up to 4 years.

Stages of Keller's disease

Keller's disease I is most often diagnosed in preschool boys aged 3 to 7 years. Initially, the child notes pain and signs of swelling on the back of the inner edge of the foot. Due to the pain, there is a constant limp in the child, who tries to lean on the opposite, outer part of the foot while walking. Typically, the disease affects only one foot. It lasts about a year, after which the pain gradually stops.

Keller II disease is most often diagnosed in teenage girls. It was first described by traumatologist Freiberg from the USA, and Keller studied this type of disease in more detail and gave its description. This form of the disease is often bilateral. As a rule, the onset of the disease goes unnoticed. Initially, pain develops in the area of ​​the head of the II or III metatarsal bones.

They immediately appear in cases where a load is placed on the forefoot, and later the patient feels pain even at rest. The appearance of lameness is gradually noted, the patient cannot walk in shoes with thin soles, it is very difficult for him to walk barefoot, especially if the surface is uneven. Where the pathological process develops - on the dorsum of the foot - swelling appears.

The finger that is located next to the head of the affected bone becomes shorter, and movements in the joint are limited. All these symptoms are present in the patient for about two years, after which the pain gradually begins to subside. However, if changes have occurred in the joint during this period, the pain may soon reappear.

The symptoms of different forms of Keller's disease vary slightly. General signs of pathology should be considered:

• pronounced pain in the affected foot when moving;
• swelling;
• limitation of functionality.

With an advanced degree of this pathology, the patient experiences increased pain, changes in gait, and lameness appears. A feature of the disease is the absence of inflammation of the affected area of ​​the foot.

Form 1 of Keller's disease is characterized by swelling of the central part of the foot - at the location of the navicular bone of the foot. When you feel the affected area of ​​the leg, pain and discomfort occur. Painful sensations intensify with physical activity of a person, and rapid fatigue appears. The patient is forced to rely on the outer part of the foot for any movements, causing lameness. Usually the pathology affects one foot.

The non-infectious nature of the disease is indicated by the absence of increased local body temperature, and there is no redness of the affected area.

The average duration of this pathological process is approximately 12 months and ends with either complete recovery or persistent deformation of the navicular bone of the foot.

In form 2 of Keller's disease, the head of the metatarsal bones is affected simultaneously in both feet. The initial stage occurs with virtually no symptoms.

Over time, during exercise, a mild pain syndrome begins to appear in the front parts of the feet. The pain goes away with rest. Upon visual examination of the patient’s feet, one can notice a clear shortening of the fingers with affected bone tissue and limitation of their movements. This form of the disease has a longer course, amounting to 2–3 years.

It is worth noting that pathological processes in children have more pronounced symptoms than in adults.

Symptoms of the 1st and 2nd forms of the disease are slightly different.

In form 1 disease, there is pain and swelling on the back of the inner edge of the foot. In this case, the child begins to limp, as he tries to step only on the outer edge of the foot to reduce pain and transfer the load when walking to the healthy leg. The child becomes less active, tries to walk less, and stops running.

He also gets tired very quickly when walking and often complains of pain in his foot. At first, pain appears only during physical activity, but as the disease progresses, the pain becomes permanent and does not go away even after a long rest. External signs of inflammation, such as redness or increased local temperature, are not observed.

Most often, the disease develops on only one foot, but occasionally both feet can be affected. The disease lasts about a year, after which the bone is gradually restored with proper treatment, or persistent deformation remains.

The second type of disease is much more often bilateral in nature, affecting both feet. Initially, the disease is practically asymptomatic and is almost never diagnosed. Sometimes it is discovered accidentally during an x-ray for another reason.

First, pain manifests itself after putting pressure on the toes or upon palpation. After rest, the pain disappears. Gradually, as the disease worsens, the pain noticeably intensifies and is permanent; it does not disappear even during a period of complete absence of stress.

The pain intensifies when walking barefoot, standing on tiptoes, or wearing shoes with thin soles. The toe next to the affected metatarsal head becomes shortened. Upon careful examination, you can notice a slight swelling at the location of the 2nd and 3rd metatarsal bones. There are no other signs of the inflammatory process.

The duration of type 2 disease is much longer compared to type 1.

Köhler's disease II most often develops in children and adolescents; it is clinically manifested by pain in the area of ​​the II-III toes, which intensifies with movement (walking, running).

Palpation reveals swelling of the affected bones without signs of arthritis.

The duration of the pain syndrome ranges from 2-3 months. up to 1 year or more; in the latter case, secondary osteoarthritis may develop.

X-ray is determined by a decrease in size and compaction of the head of the II and (or) III metatarsal bone, expansion of the joint space.

Review of Keller's disease (types 1 and 2): causes, stages, signs and treatment

(if the table is not completely visible, scroll to the right)

With pathology, fractures may occur (in the photo - a fracture of the metatarsal bone of the foot)

Keller's disease is the death of individual bones in the feet. This pathology refers to osteochondropathy – diseases accompanied by the destruction of spongy bone tissue due to a lack or complete cessation of its blood supply.

with pathological changes in the scaphoid bone

with damage to the heads of the II and III metatarsal bones of the feet.

The structure of the ankle joint

Both species have the same development mechanism. Destructions in spongy bone tissue occur due to a disorder in its blood supply - this is a chronic process that lasts a long time. Lack of oxygen and nutrients leads to the destruction of bone tissue, then aseptic necrosis develops (necrosis - necrosis, aseptic - that is, without the participation of microbes).

A characteristic feature of this pathology is the gradual destruction of bone in the absence of inflammation, followed by its restoration.

This pathology is diagnosed mainly in young children and adolescents. Keller's disease 1 is more often detected in 3-7 year old boys, the second type - in 10-15 year old girls. The development of pathology is also possible in young people 20–25 years old.

Symptoms of the disease negatively affect the child’s motor activity: pain when walking and swelling of the foot lead to changes in gait, lameness, and inability to run. The situation is complicated by microfractures in the area of ​​bone damage.

The treatment is carried out by an orthopedist; it is to him that the child should be taken if pain occurs in the area of ​​the feet. Coping with the disease is not so difficult - you just need patience and attentive attitude towards your child. And the doctor will monitor the entire process of treatment and rehabilitation and give recommendations in order to further minimize the load on the affected bones.

1. Aseptic necrosis

At this stage, bone beams related to the elements of bone structures die. There is a sharp decrease in its density; it is no longer able to withstand the previous loads.

2. Compression fracture

New beams are formed. They are not yet strong enough, so under normal loads on the foot they break, wedging into each other.

Specific cells - osteoclasts - resorb broken and dead bone beams.

The structure and shape of the bone is gradually restored. The process of full regeneration is possible only when normal blood supply to the affected area of ​​the bone is restored.

Diagnostics and tests, who to contact

To detect Keller's disease, the orthopedist performs a thorough examination of the injured leg, as well as a detailed interview with the patient. The main diagnostic method is radiography.

The images of type 1 Keller disease consistently reveal the degree of damage to the scaphoid bone, as well as its flattening and compaction, complete resorption of fragments, and then its regeneration to its original parameters.

With Keller's disease type 2, photographs show a decrease in the height of the metatarsal heads, as well as their compaction. In addition, there is a change in the articular endplate, an increase in the gap of the metatarsophalangeal joints, and bone fragmentation, all of which can also be seen on x-rays. Even after appropriate therapy, complete regeneration of the normal parameters of the damaged heads almost never occurs.

Keller's disease is diagnosed based on changes found in the bones that are affected. They can be identified using x-rays. The type of disease is determined depending on where exactly the processes of destruction or restoration of bone tissue develop. Very often, Keller disease I is diagnosed accidentally when an X-ray examination is performed for another reason.

The basis for making a correct diagnosis of Keller's disease is an X-ray examination of the affected feet at all stages of development. The photo of the pathological process clearly shows osteoporosis of the scaphoid bone tissue or metatarsal heads, which was caused by the destruction of their spongy element.

On successive x-rays of the affected foot with Keller's disease of the 1st form, one can observe compaction of the scaphoid bone tissue, its flattening, and the resorption of some of its elements. But with proper treatment, the restoration stage of the bone to its previous size can be traced.

In case of form 2 disease, radiography reveals pathological changes in the metatarsophalangeal joints, a decrease in the height and compaction of the heads of the metatarsal bones, and their fragmentation. In this case, proper treatment will not lead to complete restoration of the affected bones of the feet.

A study of the advanced form of the disease with the progression of the necrotic process shows fragmentary defragmentation of the scaphoid bone, metatarsal heads, and pathological microfractures of the bones of the affected areas.

When diagnosing patients with Keller's disease, detailed conversations are important in order to identify characteristic signs of pathology.

The doctor makes the diagnosis based on the results of a visual examination and radiographs of the feet. Based on the characteristic changes on x-rays, the orthopedist determines the type and stage of the disease.

• In the first stage of Keller's disease I, osteoporosis of the scaphoid bone is visualized radiographically, resulting from necrotic destruction of its spongy substance.
• Photographs taken later show compaction and flattening of this bone, with visible points of ossification.
• Even later images reveal the breakdown of the bone into separate fragments (defragmentation), due to the progression of necrosis. Signs of a fracture are visible.

In Keller's disease II, the radiological signs of necrotic destruction are the same, only they are localized in the heads of the metatarsal bones of the toes.

To diagnose the disease, the orthopedist examines the sore leg, as well as interviews the child or his parents. The main diagnostic method is radiography.

On X-ray photographs of Keller disease 1, the stages of destruction of the scaphoid bone, its compaction and flattening, complete resorption of some fragments, and then its restoration almost to its original size are successively determined.

With Keller's disease type 2, the photographs show a decrease in the height of the heads of the metatarsal bones, as well as their compaction. Changes in the articular endplate, widening of the metatarsophalangeal joint gap, and fragmentation of the metatarsal bones are also observed. After treatment, complete restoration of the normal size of the heads of these bones almost never occurs.

For such complaints, people usually contact an orthopedist or traumatologist.

To exclude an infectious pathogen, the blood is checked for leukocyte levels and other indicators. If necessary, the specialist may decide to continue the examination, but, as a rule, an x-ray is sufficient.

The photo shows x-rays of bones affected by Freiberg-Keller disease I and II

Treatment of Köhler's disease 2

Treatment is carried out traditionally: medications, physiotherapy, exercise. The latter must be dosed by a doctor together with an experienced instructor.

Considering the ease of formation of cracks and fractures, at first doctors recommend refraining from any type of stress.

Medication

At the same time, doctors can prescribe physical therapy for this type of osteochondropathy.

Physiotherapy

If we talk about physiotherapy, doctors give preference to various methods of influence. Among the most popular remain:

• Ozocerite therapy;
• Electrophoresis;
• UHF therapy;
• Paraffin treatment;
• Darsonval;
• Microwave currents;
• Mud therapy and so on.

As mentioned earlier, for the first time, complete abstinence from exercise is suggested, including therapeutic exercises, especially if the disease has already entered the second stage, that is, a compression fracture.

It is important to understand that in the process you should never injure a joint that is susceptible to destruction.

Treatment of both types of Keller disease follows the same type of treatment.

The recovery period after removing a cast or undergoing surgery should be taken with particular seriousness. It is important to limit the child’s motor activity: avoid jumping, running and any active games. Choose orthopedic shoes for him, when worn, the feet will retain their anatomically correct shape (special insoles will reduce pressure on the bones affected by necrosis).

As a result, nutrition and regeneration of damaged tissues will occur faster.

The effectiveness of therapy for this pathology directly depends on the timeliness of diagnosis and the correct selection of the regimen. In the early stages of the formation of aseptic necrosis in children, conservative treatment is carried out, which involves the use of several techniques:

• eliminating excess load from the foot by completely immobilizing the injured limb - applying a plaster cast for 1-2 months;
• unloading of the foot through the use of orthopedic insoles, arch supports, pads, thereby eliminating tension from the navicular and metatarsal bones;
• using analgesics to block pain;
• use of general and local anti-inflammatory medications to eliminate swelling and pain;
• the use of preparations based on phosphorus and calcium, which help balance metabolism and stimulate bone tissue restoration;
• physiotherapy – herbal baths, heat therapy, electrophoresis;
• Exercise therapy is an integral component of the treatment of Keller's disease in adults and children during the recovery stage and involves performing a certain set of exercises.

Both in the case of the disease of the first type and in the pathology of the second form, surgical intervention is prescribed to patients extremely rarely, exclusively in advanced stages.

In Keller's disease I, osteochondropathy affects the scaphoid bone. During the development of this type of disease, a fracture of the scaphoid bone occurs. Treatment of the disease, as a rule, occurs after an accidental diagnosis, when the doctor identifies a closed fracture of the foot bone. X-rays of this type of disease clearly show how the navicular bone of the foot is destroyed. It should be noted that if the scaphoid bone of the hand is affected, then we are talking about Ireiser’s disease, and not Keller’s disease.

Typically, Keller disease 1 is treated with conservative therapy. If during the diagnostic process a fracture of the scaphoid bone of the hand was identified, then treatment is carried out using a plaster cast. If the foot is affected, it is necessary to ensure its unloading and subsequent immobilization. A foot that hurts must be kept motionless.

In most cases, a cast on the foot or hand (if the wrist is affected) is applied for four weeks. After removing the cast, a child who has previously experienced aseptic necrosis must be limited in mobility. Sometimes the patient is advised to walk with a cane or move with the help of crutches. After removing the cast, it is advisable for the child to wear special insoles, which are made to order.

If insoles are made correctly, then their use makes it possible to reduce the pressure that falls on the scaphoid bone. Consequently, the child does not suffer from severe pain, and tissue nutrition is restored faster. A very important point in the treatment process is that the child wears correctly selected orthopedic shoes, which allow him to maintain the correct shape of the foot.

There is no need to jump or run during the recovery period so that a crack does not form in the bones of the foot. In addition, if the bones do not heal immediately after a fracture, a false joint may form later. With this condition, the structure, as well as the shape of the opposing bone fragments, changes. Sometimes, in this case, surgery is required, so the rehabilitation period for Keller's disease should be treated with special attention.

In order for the bone to recover faster, the patient is prescribed medications that help improve blood circulation and metabolism in the body. The patient is prescribed medications that activate the metabolism of calcium and phosphorus in the body. Vitamins B and E may be prescribed, as well as complex vitamin preparations that contain calcium in a bioavailable form.

Surgical treatment is practiced relatively rarely. However, when severe pain is noted, and the effect of conservative therapy is not observed, revascularizing osteoperforation is possible. During this operation, small canals are made in the scaphoid bone, in which new vessels grow relatively quickly.

Provided the correct approach to treatment and timely application of all these methods, the child recovers, and no dysfunction of the foot is noted after the illness. But if the disease is not treated, which happens very often due to lack of diagnosis, the shape of the scaphoid bone is often disrupted, and the child develops flat feet.

Treatment of Keller disease 2 consists primarily of restricting movement. This is achieved by applying a plaster cast to the foot. This bandage should be worn for 3-4 weeks, and after removing it, you should avoid too much strain. In addition, physiotherapeutic procedures and massage sessions for the muscles of the foot and lower leg are prescribed.

Complications of Keller's disease in the absence of adequate treatment can include deformation of the musculoskeletal system, osteoarthritis, flat feet, and joint contracture.

Keller's disease is a type of osteochondropathy (degenerative changes in the spongy tissue of the bones of the foot). Most often, the pathology occurs in childhood and adolescence, but can also be observed in adults. It is necessary to understand in detail the causes of the disease, symptoms and the main forms of control and prevention.

Immobilization of the sore foot

The application of a plaster cast in the form of a boot helps to completely unload the foot, which needs to be worn for 1 month, sometimes longer

Taking non-narcotic analgesics for pain relief

Medicines that activate calcium metabolism

Drugs that improve peripheral circulation

One of the vitamin-mineral complexes

After removing the plaster cast, foot massage and physiotherapy are prescribed - mud therapy, magnetic therapy, foot baths, reflexology, iontophoresis, electrophoresis

Exercises specially selected by a physical therapy doctor help develop the foot after long immobilization and restore its functionality.

If conservative treatment is ineffective, revascularizing osteoperforation is indicated - surgically creating holes in the bone to improve arterial blood flow. Due to them, bone tissue is better supplied with blood, bypassing the affected vessels.

Keller's disease, the treatment of which involves the use of conservative methods, first of all requires minimizing the load on the affected leg.

For Keller's disease 1, a plaster cast is required, which provides support to the bones of the foot and significantly reduces the load on them. The bandage is applied for a period of 4-6 weeks.

The time to wear the bandage depends on the degree of damage and duration of the disease. After its removal, restriction of mobility is required for some time. It is also recommended to wear special orthopedic shoes or shoes with orthopedic insoles.

Keller's disease of the second type, the treatment of which is practically no different from the first type of disease, also requires the application of an immobilizing splint. It is worn for at least a month. After removal, massages, exercise therapy and the use of physiotherapeutic techniques are also recommended. Until the foot is completely restored, special orthopedic shoes are required.

Keller's disease involves the use of medications as part of complex therapy for both types of disease.

Treatment consists of using orthotic insoles to relieve weight on the forefoot. In cases of severe pain, analgesics, NSAIDs, and local therapy (anti-inflammatory creams, ointments, gels, etc.) are prescribed.

It is especially effective to use methods aimed at improving bone trophism in combination, that is, the simultaneous use of massage, physiotherapy, acupuncture, and in combination with drug therapy.

Köhler's disease - treatment in Moscow

Physiotherapy

Keller's pathology is a chronic osteochondropathy that occurs as a result of degenerative changes in the spongy substance of tubular bones and often causes the development of aseptic necrosis or microfractures in the affected areas. The anomaly involves the scaphoid and metatarsal bones.

The defect is found in patients of completely different ages, but most often young organisms are affected.

Keller's disease in children is much more aggressive than in adult patients and is characterized by pronounced symptoms, a malignant form and many signs that require immediate response and medical care.

It has long been known that the best effect in the treatment of diseases is achieved with the combined use of “Western” and “Eastern” approaches. Treatment time is significantly reduced, the likelihood of disease relapse is reduced
. Since the “eastern” approach, in addition to techniques aimed at treating the underlying disease, pays great attention to the “cleansing” of blood, lymph, blood vessels, digestive tracts, thoughts, etc. - often this is even a necessary condition.

The consultation is free and does not oblige you to anything. It is highly desirable to include all the data from your laboratory and instrumental research methods.
over the last 3-5 years. By spending just 30-40 minutes of your time, you will learn about alternative treatment methods and learn how to increase the effectiveness of already prescribed therapy
, and, most importantly, about how you can fight the disease yourself. You may be surprised how logically everything will be structured, and understanding the essence and reasons is the first step to successfully solving the problem!

Summary

Although Keller's disease lasts for many months and sometimes with minimal symptoms, treatment should begin when its first signs appear. This will help avoid serious complications such as joint contracture, the development of osteoarthritis, worsening flat feet, and the formation of irreversible foot deformity due to a fracture of the scaphoid bone or its destruction.

Buying comfortable shoes of the right size, timely treatment of flat feet and pathologies of the endocrine system, and avoiding injuries will help prevent the occurrence of Keller's disease.

At the top of the comments feed are the last 25 question-answer blocks. I answer only those questions where I can give practical advice in absentia - this is often impossible without personal consultation.

Good afternoon. My daughter was diagnosed with stage 2 Keller disease. Apart from physiotherapy and self-massage, physical therapy exercises, the doctor did not prescribe anything. My daughter practices professional Latin American dancing (waltz, samba, etc.). Doctors in our city claim that dancing is useful for this diagnosis.

Hello. I have had Keller's disease since I was 13 years old. Now 43. Doctors shrug their shoulders, saying the operation is pointless. I have severe pain. Even in the most comfortable shoes, spontaneous attacks of pain occur. Tell me, please, where is the best place to go?

Anna, basic therapy for your disease should include immobilization of the affected foot, limitation of physical activity, use of medications, therapeutic exercises, massage, and physiotherapy. You can relieve or reduce pain by using NSAIDs (Ibuprofen, Diclofenac injections).

The drugs Actovegin and Tanakan will help improve peripheral blood circulation in the affected area and improve bone nutrition. Homeopathic remedies Traumeel S and Osteochel S have been proven to have a positive effect on the condition of bone tissue. Complexes of vitamins and minerals are also needed that activate phosphorus-calcium metabolism in the body, for example, Aquadetrim, multivitamin preparations;

Do they enroll in the army with Keller's disease?

Hello Olga. It depends on how much the foot bones are deformed. The conclusion will be given by a traumatologist or orthopedist. Afterwards the commission will make its verdict.

Good afternoon, I am 22 years old and 12 years old, I have grade 2.4 Keller’s disease and for the last month it has become painful for me to walk, with the feeling that my finger will soon fall off, and the width of the hole, or whatever it is correctly called, is becoming larger. They prescribed me insoles and pills, but it doesn’t help.

Hello, Lena. For successful treatment, you need to identify the cause of the disease and first act on it. The treatment itself is long and must be persistent and comprehensive. If pathological changes have occurred in the metatarsophalangeal joints, a decrease in the height and compaction of the heads of the metatarsal bones, and their fragmentation, then in this case treatment will not lead to a complete restoration of the affected bones of the feet.

Good afternoon My 4-year-old son developed lameness and pain on the top of his foot. CT scan showed early stage 1 Keller disease. The orthopedist prescribed us the drugs osteogenon and trental, as well as physical therapy (first electrophoresis with novocaine and calcium, then magnets and laser). Is the treatment prescribed correctly or does something else need to be added?

Good day, Elena. Keller's disease in children behaves more aggressively, compared to a similar disease in adults, and is characterized by a pronounced clinical picture, a malignant course and a number of symptoms that require immediate response from the child's parents and doctors.

The effectiveness of treatment depends mainly on timely diagnosis. In the early stages, conservative treatment of the disease is carried out, which is implemented using the following methods: unloading the foot using the method of complete immobilization of the affected limb (plaster casting for 1-2 months);

unloading the foot through the use of orthopedic insoles, pads, instep supports, which help relieve tension from the bones of the metatarsus and navicular bone; the use of analgesics and anti-inflammatory drug forms of local and general action; physiotherapy and exercise therapy are mandatory. Warm foot baths with sea salt are also recommended.

Writing a forecast in advance is inadequate. Children often go through many diseases during a transitional period, and the fact that you begin treatment right away gives you confidence in getting rid of the disease.

Hello. I’m 28 years old. I have Keller disease 2. It’s been progressing for a very long time, since I was 14 years old. Doctors say I need surgery, but I have fear and a question, what if I can’t walk fully? Tell me, are there any terrible consequences after the disease?

Irina, there is an osteoplastic surgery for Keller’s disease 2, which consists of osteotomy of the metaphysis of the metatarsal bone in order to create the most favorable conditions for the rapid regeneration of the necrobiotically altered area of ​​the bone. A disadvantage may be that the deformed metatarsal epiphysis is not corrected.

There is another known method of osteoplastic surgery, which consists in resection of the affected head of the metatarsal bone with transplantation of a piece of adipose tissue into the cavity formed after resection. The disadvantage of this operation is that transplanting a piece of adipose tissue into the formed cavity does not prevent the retraction of the finger and all the ensuing consequences. There are other methods of surgical treatment.

Which method will be chosen in your case, what consequences there may or may not be, you must discuss everything with the surgeon. In any case, if I offer you surgery, you must agree.

Hello, 4 years ago I started having pain in my feet, and I did an examination and it turned out to be Keller’s disease 2. The traumatologist prescribed me a massage, paraffin and treatment with electric current (I already forgot), the pain went away a little and after that I was already treated. I wanted to ask, is it too late for treatment? It’s just that this pain has become a habit and I don’t pay attention to it. And in what ways to treat? Thank you in advance

Hello Raushan. To determine how far the disease has developed and what can help you, you need an examination and research. In any case, it needs treatment. And first of all, the effect is achieved by unloading the foot and creating conditions for its immobilization. For better restoration of bone tissue, means are used to improve blood circulation and metabolic processes.

You can try treating the disease with folk remedies, starting with warm baths in a solution of sea salt. To prepare the solution, you need to dissolve 400 grams in warm water. sea ​​salt. After this, the feet are lowered into the bath for half an hour. Then the feet are rinsed and wiped dry.

Keller's disease is a type of osteochondropathy, which is characterized by necrosis of the bone tissue of the feet. The disease was named after the German radiologist who was the first to describe its symptoms.

This disease is most common in childhood and adolescence, but can also occur in adults. Therefore, any changes in gait in children, the appearance of swelling of the foot and complaints of pain should not be ignored by parents. A child with such symptoms must be shown to an orthopedic doctor who can make the correct diagnosis.

Etiology

The clinical picture of this defect manifests itself in the form of many typical signs. Typically, the development of the disease begins with swelling of the soft tissues of the dorsum of the foot, which indicates the progression of degenerative processes in the bones.

The tumor is not characterized by any signs, it is practically not accompanied by pain - they can only occur when running or walking.

A few days after the onset of edema, it goes away on its own, bringing the visible effect of apparent recovery. In fact, such a miraculous disappearance of the tumor should not be ignored under any circumstances, since it indicates the transition of Keller's disease to the next stage.

Signs

Sometimes the pathology can be completely asymptomatic. In patients who do not even suspect the presence of an anomaly in their body, the disease is often discovered quite by accident, for example, during a routine examination or x-ray. In the absence of timely treatment, Keller's disease can lead to more serious consequences, including:

• the formation of all kinds of foot deformities or complex types of flat feet;
• development of arthrosis;
• disorders in the functioning of small joints.

In 6% of all cases the disease leads to disability.

Classification

Keller's disease type 1 in children is characterized by swelling in the area of ​​the navicular bone and its projection onto the dorsum of the foot. However, other signs of inflammation, such as a local increase in skin temperature or hyperemia, may be completely absent. This suggests that the pathology is non-infectious in nature.

Almost simultaneously with the appearance of a tumor near the scaphoid bone, a pain syndrome occurs, the intensity of which increases during physical exertion on the distal limbs. As a result of constantly increasing pain, the child gradually begins to limp and lean on the outer edge of the foot. Over time, the pain syndrome becomes constant and bothers the patient even in a state of complete rest.

Keller's disease type 2 occurs most often in girls during puberty and manifests itself as a swelling. Patients complain of pain in the metatarsal bones. As in the case of the first type of disease, there are no signs of the inflammatory process.

Initially, the pain appears while walking and is localized in the forefoot. As the defect develops, pain in the metatarsal bones increases and becomes constant. In adults, Keller disease type 2 usually lasts for about 2-3 years, after which it transforms into aseptic necrosis of the affected area or its fragmentation into small fragments. The consequences of this pathology can significantly affect the quality of life of the affected person.

Basic therapy

• Treatment of Keller's disease in both children and adults involves the use of medications as part of a comprehensive regimen.
• Non-steroidal anti-inflammatory drugs and non-narcotic analgesics. These medications are recommended to patients to relieve pain. Since the disease most often manifests itself in childhood, drugs containing ibuprofen or paracetamol are used as painkillers. Other medications are usually not used in pediatrics. When treating adult patients, it is permissible to use other drugs from this category.
• Preparations for stabilizing phosphorus-calcium metabolism. The use of drugs in this group helps to restore bone tissue as quickly as possible and compensate for the lack of microelements in the body. In such situations, doctors often prescribe Aquadermit, preparations containing calcium, and all kinds of multivitamin complexes.
• Means for improving peripheral blood flow. Their use is necessary to normalize proper blood circulation and stabilize the supply of bone tissue. Taking into account the patient’s age, the following can be prescribed: “Actovegin”, “Trental”, “Cavinton”, “Cinnazarin”, “Bilobil”, “Stugeron”, “Pentoxifylline”, “Tanakan”.

Traditional conservative treatments for Keller disease include:

• immobilization of the affected foot;
• limiting physical activity;
• use of medications;
• therapeutic exercises;
• massage;
• physiotherapy.

Immobilization of the sore foot is carried out as follows. A plaster cast is applied to the sore spot for 1-2 months, modeling the shape of the foot. It is necessary to completely protect the affected area of ​​the leg from any physical activity, which will stop further necrotic development of the bones and stop their deformation. During this period, the patient can move around with the help of crutches.

After removing the cast, it is necessary to provide a gentle load for the sore foot using orthopedic shoes, special insoles, pads, etc. Active and sudden movements, running, and long walking should be avoided for a long time.

Symptoms characteristic of this disease in the form of pain and swelling are eliminated with medications. You can relieve or reduce pain by using non-narcotic analgesics and NSAIDs (Ibuprofen, Paracetamol).

Medicines and complexes of vitamins and minerals are prescribed that activate phosphorus-calcium metabolism in the body. These include Aquadetrim, multivitamin preparations, and products containing calcium.

The drugs Actovegin, Tanakan, etc. will help improve peripheral blood circulation in the affected area and improve bone nutrition. Homeopathic remedies Traumeel S, Osteohel S, etc. have been proven to have a positive effect on the condition of bone tissue.

Restorative treatment methods include: massage, exercise therapy, physiotherapy. Special exercises and massage will help develop the sore foot and restore its functionality.

A variety of physiotherapeutic procedures will help to significantly shorten the recovery period of the foot after plaster removal and prevent irreversible deformation of the bones of the feet. Physiotherapy may include: electrophoresis, iontophoresis, reflexology, foot baths, etc.

When treating this pathology with folk remedies, mandatory consultation with the attending orthopedic surgeon is necessary.

Folk recipes

This method of treatment is aimed only at eliminating unpleasant symptoms: relieving pain and eliminating swelling.

This therapy begins with the use of thermal baths, which are made using simple sea salt. Feet should be immersed in a hot solution for half an hour, and then rinsed and wiped dry. This procedure is recommended to be carried out daily, preferably in the evenings. Treatment of Keller's disease using folk recipes can be combined with traditional medicine. But this can only be done with the permission of the attending physician.

Of course, type 2 disease requires more serious therapy to ensure complete immobilization of the distal parts of the injured limb. Traditional medicine in this case can only reduce the intensity of the pain syndrome. That is why, when the first alarming signs of pathology occur, it is necessary to urgently consult an orthopedist.

Surgery

In case of type 1 anomaly, during surgery two canals are made in the scaphoid bone, into which vessels subsequently grow and provide the necessary nutrition to the tissues. Usually, after surgery, the pain quickly subsides and does not return. During the rehabilitation period, the patient is recommended to undergo a course of massage, physiotherapeutic procedures and exercise therapy.

When Keller disease type 2 is detected, surgery is required much less frequently. Surgical intervention is necessary only when deforming osteoarthritis occurs. In such situations, bone growths are eliminated, and the head of the metatarsus is given a specific spherical shape. The entire bone cannot be resected, as this may cause the limb to lose significant support.

How to treat Keller's disease if conservative methods of combating it are ineffective? In this case, surgery will help.

Physiotherapy, exercise therapy, and therapeutic massage will help speed up the recovery process.

Resection arthroplasty (endoprosthetics) is a serious operation to completely replace or reconstruct a joint damaged by Keller's disease using natural material - fascia, skin, human bones. Indications for surgical treatment of this type should be considered:

• severe pain in the foot that cannot be relieved with medications;
• significant restrictions on joint movement.

During resection arthroplasty, the deformed area of ​​the joint is excised and removed, a new one is modeled and its mobility is restored. With proper surgical intervention, the patient recovers completely and returns to his normal lifestyle.

Preventive measures

As you know, any defect is always much easier to prevent than to treat. Prevention of Keller's disease in children and adults involves:

• correct choice of shoes;
• refusal of excessive physical activity;
• systematic examinations in medical institutions;
• timely treatment of various injuries;
• early diagnosis of problems associated with foot deformities.

Keller's diseases 1 and 2 refer to osteochondropathy - pathologies of bone and cartilage tissue that develop on the basis of local circulatory failure.

To prevent the development of this disease in children, you should:

• do not allow serious physical activity before the age of 7 years;
• choose the right and comfortable shoes;
• timely prevention and treatment of foot deformities;
• promptly identify diseases of the endocrine system and carry out their treatment;
• consult a doctor in a timely manner if your child has any complaints;
• Treat injuries promptly and correctly.

OSTEOCHONDROPATHY OF THE HEAD OF THE II-III MATARSAL BONE (KOHLER'S DISEASE II)

The disease was first described by A. Kohler in 1920; it is based on aseptic necrosis of the epiphysis of the head of the II-III metatarsal bone.

Prevention of osteochondropathy

Keller's disease 1 is called osteochondropathy of the scaphoid bone. The vast majority of patients are young children (from 3 to 12 years). Pathological changes can be observed on both feet at once. According to clinical statistics, boys are much more likely to get sick than girls. The disease usually lasts for 8–15 months. Then the symptoms begin to slowly subside.

Keller's disease 1 develops gradually. Usually, the first manifestations of osteochondropathy of the navicular bone are the appearance of pain on the dorsum of the foot. Features of the clinical picture:

• In general, increased pain is observed when walking and physical activity.
• Complaints of increased leg fatigue.
• Sometimes pain is observed at night.
• Feeling the back of the foot can cause some pain.
• Due to severe painful sensations, characteristic lameness appears. The child tries to walk, leaning on the outer edge of the foot.
• Some swelling may be detected in the area of ​​the dorsal surface, but without clinical symptoms of the inflammatory process.

Diagnostics

The main method for diagnosing Keller disease 1 is a survey radiography of the feet, which allows us to identify the initial signs, disruption of the ossification processes of the scaphoid bone and its deformation. In addition, nearby joint spaces may be slightly widened. But what to do when bone pathology is not yet observed (pre-radiological stage)? In the early stages of disease development, high-resolution diagnostic methods will help identify the pathological process:

• CT scan.
• Densitometry (determination of bone tissue density).

An arsenal of diagnostic methods makes it possible to identify even the most minor changes in the structure of the bones and joints of the foot. In case of osteochondropathy of the navicular bone of the foot, it is also necessary to do clinical blood tests to exclude the presence of inflammation.

Treatment

The main goal of treatment of all forms of osteochondropathy, including Keller's disease 1, is to ensure the restoration of normal development of bone that has undergone pathological disorders. It is necessary to ensure that at the end of the formation of the skeleton the bone has optimal size and shape. If you completely complete the entire therapeutic course prescribed by your attending physician, then it is quite possible to obtain a complete cure.

As soon as a child is diagnosed with Keller disease 1, physical activity on the affected limb is immediately completely eliminated. The foot should be immobilized (immobilized) by applying a plaster boot or splint for a period of 30–45 days. After cessation of immobilization, it is recommended to limit physical stress on the foot and wear it. In addition, various types of physiotherapeutic treatment are actively used, including:

• Electrophoresis with vasodilator drugs.
• Ultrasound therapy.
• Electrotherapy.
• Balneotherapy.
• Mud applications.

The course of treatment and recovery is prescribed by a specialist doctor (usually an orthopedist), taking into account the stage of the disease and the condition of the child.

Keller's disease 2 is an osteochondropathy of the metatarsal heads. The main category of patients are children, adolescents and young men aged 10 to 21 years. Statistics show that boys suffer more often than their peers. The duration of the disease is 1–3 years and depends on the timeliness and effectiveness of therapy.

The second and third metatarsal bones are most often affected.

Prevention plays an important role in preventing the development of osteochondropathy. First of all, it is necessary to exclude possible causes and risk factors. Weight control, avoidance of injuries and damage, treatment of secondary osteoarticular pathology, and correction of endocrine disorders are of decisive importance. What other recommendations for the prevention of Keller diseases 1 and 2 can doctors give:

1. Maintain optimal movement patterns.
2. Regular sports, especially in childhood, contribute to the proper formation of the musculoskeletal system.
3. Balanced diet.
4. Identification of risk groups (eg).

Do not ignore preventive medical examinations, which will help identify pathology at an early stage of its development. In addition, it is necessary to contact a specialist immediately after the first clinical symptoms of the disease appear.

This disease was first described by radiologist Keller from Germany; this happened at the beginning of the last century.

When a person develops Keller's disease, the body experiences disruption of blood flow to the bones of the foot. As a result, the feet do not receive the required amount of oxygen and a number of nutrients necessary for the normal functioning of tissues. The process of bone tissue death begins, which in medicine is commonly called aseptic necrosis.

Köhler's disease I is characterized by the appearance of swelling on the back of the foot closer to its inner edge, caused by swelling of the tissues of this area. The absence of redness of the skin and local increase in temperature in the area of ​​edema indicates the non-inflammatory nature of the changes occurring. The affected area is painful when palpated and when putting pressure on the foot, and the child becomes tired when walking. To avoid pain when walking, children with Köhler's disease place their foot on the outer edge of the foot. Lameness may occur. Over time, the pain intensifies and becomes permanent, not disappearing even with complete rest. Köhler's disease I lasts on average about a year and can lead to permanent deformation of the scaphoid.

Symptoms of Kohler's disease II.

Köhler's disease II causes swelling and tenderness in the area of ​​the affected metatarsal bone. The most common lesions are the II and III metatarsal bones. The pathological changes may be bilateral. In this case, symptoms of inflammation are not observed. Köhler's disease II begins with the appearance of a mild pain syndrome, which initially manifests itself only when the forefoot is loaded. Typically, the pain increases when palpating the affected area and while walking, especially on uneven ground or in shoes with too thin and soft soles. Over time, patients complain that the pain in the foot becomes constant, more intense and persists even at rest. There is a shortening of the finger, which is adjacent to the head of the metatarsal bone that has undergone necrosis. The range of motion in the joint formed by the affected metatarsal bone is limited. Köhler's disease II lasts on average for 2-3 years.

Today very little information is known about the pathology, the features of which were told to the world back in the last century by the German radiologist Keller. The disease, named after its discoverer, is an aseptic necrosis of the scaphoid bone or metatarsal heads, due to which the disease belongs to the category of osteochondropathy.

Pathological changes in the foot of this kind appear most often in childhood, although medicine knows of cases in which adults were affected by anomalies. Keller's disease is often diagnosed in boys aged 5-7 years and teenage girls.

General information

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Keller's pathology is a chronic osteochondropathy, which occurs as a result of degenerative changes in the spongy substance of tubular bones and often causes the development of aseptic necrosis or microfractures in the affected areas. The anomaly involves the scaphoid and metatarsal bones.

The defect is found in patients of completely different ages, but most often young organisms are affected.

Keller's disease in children is much more aggressive than in adult patients and is characterized by pronounced symptoms, a malignant form and many signs that require immediate response and medical care.

Causes

According to doctors, pathology, regardless of its type, appears against the background of disorders of adequate blood flow in the tissues of the foot, which deteriorates their supply of micronutrients and oxygen. The ICD-10 code for Keller's disease is M92.

Various conditions contribute to the emergence of this process, including:

• tissue injury;
• chronic and acute intoxication;
• hormonal imbalances;
• disturbances in metabolic processes;
• infection of the distal extremities;
• prolonged use of uncomfortable or too tight shoes;
• acquired and hereditary foot deformities;
• congenital abnormalities of blood flow.

Etiology

The clinical picture of this defect manifests itself in the form of many typical signs. Typically, the development of the disease begins with swelling of the soft tissues of the dorsum of the foot, which indicates the progression of degenerative processes in the bones.

Of course, type 2 disease requires more serious therapy to ensure complete immobilization of the distal parts of the injured limb. Traditional medicine in this case can only reduce the intensity of the pain syndrome. That is why, when the first alarming signs of pathology occur, it is necessary to urgently consult an orthopedist.

Surgery

In case of type 1 anomaly, during surgery two canals are made in the scaphoid bone, into which vessels subsequently grow and provide the necessary nutrition to the tissues. Usually, after surgery, the pain quickly subsides and does not return. During the rehabilitation period, the patient is recommended to undergo a course of massage, physiotherapeutic procedures and exercise therapy.

When Keller disease type 2 is detected, surgery is required much less frequently. Surgical intervention is necessary only when deforming osteoarthritis occurs. In such situations, bone growths are eliminated, and the head of the metatarsus is given a specific spherical shape. The entire bone cannot be resected, as this may cause the limb to lose significant support.

Preventive measures

As you know, any defect is always much easier to prevent than to treat. Prevention of Keller's disease in children and adults involves:

• correct choice of shoes;
• refusal of excessive physical activity;
• systematic examinations in medical institutions;
• timely treatment of various injuries;
• early diagnosis of problems associated with foot deformities.

Today very little information is known about the pathology, the features of which were told to the world back in the last century by the German radiologist Keller. The disease, named after its discoverer, is an aseptic necrosis of the scaphoid bone or metatarsal heads, due to which the disease belongs to the category of osteochondropathy.

Pathological changes in the foot of this kind appear most often in childhood, although medicine knows of cases in which adults were affected by anomalies. Keller's disease is often diagnosed in boys aged 5-7 years and teenage girls.

General information

Keller's pathology is a chronic osteochondropathy that occurs as a result of degenerative changes in the spongy substance of tubular bones and often causes the development of aseptic necrosis or microfractures in the affected areas. The anomaly involves the scaphoid and metatarsal bones.

The defect is found in patients of completely different ages, but most often young organisms are affected.

Keller's disease in children is much more aggressive than in adult patients and is characterized by pronounced symptoms, a malignant form and many signs that require immediate response and medical care.

Causes

According to doctors, pathology, regardless of its type, appears against the background of disorders of adequate blood flow in the tissues of the foot, which deteriorates their supply of micronutrients and oxygen. The ICD-10 code for Keller's disease is M92.

Various conditions contribute to the emergence of this process, including:

• tissue injury;
• chronic and acute intoxication;
• hormonal imbalances;
• disturbances in metabolic processes;
• infection of the distal extremities;
• prolonged use of uncomfortable or too tight shoes;
• acquired and hereditary foot deformities;
• congenital abnormalities of blood flow.

Etiology

The clinical picture of this defect manifests itself in the form of many typical signs. Typically, the development of the disease begins with swelling of the soft tissues of the dorsum of the foot, which indicates the progression of degenerative processes in the bones.

The tumor is not characterized by any signs, it is practically not accompanied by pain - they can only occur when running or walking.

A few days after the onset of edema, it goes away on its own, bringing the visible effect of apparent recovery. In fact, such a miraculous disappearance of the tumor should not be ignored under any circumstances, since it indicates the transition of Keller's disease to the next stage.

Signs

Sometimes the pathology can be completely asymptomatic. In patients who do not even suspect the presence of an anomaly in their body, the disease is often discovered quite by accident, for example, during a routine examination or x-ray. In the absence of timely treatment, Keller's disease can lead to more serious consequences, including:

• the formation of all kinds of foot deformities or complex types of flat feet;
• development of arthrosis;
• disorders in the functioning of small joints.

In 6% of all cases the disease leads to disability.

Classification

Keller's disease type 1 in children is characterized by swelling in the area of ​​the navicular bone and its projection onto the dorsum of the foot. However, other signs of inflammation, such as a local increase in skin temperature or hyperemia, may be completely absent. This suggests that the pathology is non-infectious in nature.

Almost simultaneously with the appearance of a tumor near the scaphoid bone, a pain syndrome occurs, the intensity of which increases during physical exertion on the distal limbs. As a result of constantly increasing pain, the child gradually begins to limp and lean on the outer edge of the foot. Over time, the pain syndrome becomes constant and bothers the patient even in a state of complete rest.

Keller's disease type 2 occurs most often in girls during puberty and manifests itself as a swelling. Patients complain of pain in the metatarsal bones. As in the case of the first type of disease, there are no signs of the inflammatory process.

Initially, the pain appears while walking and is localized in the forefoot. As the defect develops, pain in the metatarsal bones increases and becomes constant. In adults, Keller disease type 2 usually lasts for about 2-3 years, after which it transforms into aseptic necrosis of the affected area or its fragmentation into small fragments. The consequences of this pathology can significantly affect the quality of life of the affected person.

Diagnostics

To detect Keller's disease, the orthopedist performs a thorough examination of the injured leg, as well as a detailed interview with the patient. The main diagnostic method is radiography.

The images of type 1 Keller disease consistently reveal the degree of damage to the scaphoid bone, as well as its flattening and compaction, complete resorption of fragments, and then its regeneration to its original parameters.

With Keller's disease type 2, photographs show a decrease in the height of the metatarsal heads, as well as their compaction. In addition, there is a change in the articular endplate, an increase in the gap of the metatarsophalangeal joints, and bone fragmentation, all of which can also be seen on x-rays. Even after appropriate therapy, complete regeneration of the normal parameters of the damaged heads almost never occurs.

General principles of treatment of Keller's disease

The effectiveness of therapy for this pathology directly depends on the timeliness of diagnosis and the correct selection of the regimen. In the early stages of the formation of aseptic necrosis in children, conservative treatment is carried out, which involves the use of several techniques:

• eliminating excess load from the foot by completely immobilizing the injured limb - applying a plaster cast for 1-2 months;
• unloading of the foot through the use of orthopedic insoles, arch supports, pads, thereby eliminating tension from the navicular and metatarsal bones;
• using analgesics to block pain;
• use of general and local anti-inflammatory medications to eliminate swelling and pain;
• the use of preparations based on phosphorus and calcium, which help balance metabolism and stimulate bone tissue restoration;
• physiotherapy – herbal baths, heat therapy, electrophoresis;
• Exercise therapy is an integral component of the treatment of Keller's disease in adults and children during the recovery stage and involves performing a certain set of exercises.

Both in the case of the disease of the first type and in the pathology of the second form, surgical intervention is prescribed to patients extremely rarely, exclusively in advanced stages.

Drug therapy

• Treatment of Keller's disease in both children and adults involves the use of medications as part of a comprehensive regimen.
• Non-steroidal anti-inflammatory drugs and non-narcotic analgesics. These medications are recommended to patients to relieve pain. Since the disease most often manifests itself in childhood, drugs containing ibuprofen or paracetamol are used as painkillers. Other medications are usually not used in pediatrics. When treating adult patients, it is permissible to use other drugs from this category.
• Preparations for stabilizing phosphorus-calcium metabolism. The use of drugs in this group helps to restore bone tissue as quickly as possible and compensate for the lack of microelements in the body. In such situations, doctors often prescribe Aquadermit, preparations containing calcium, and all kinds of multivitamin complexes.
• Means for improving peripheral blood flow. Their use is necessary to normalize proper blood circulation and stabilize the supply of bone tissue. Taking into account the patient’s age, the following can be prescribed: “Actovegin”, “Trental”, “Cavinton”, “Cinnazarin”, “Bilobil”, “Stugeron”, “Pentoxifylline”, “Tanakan”.

Folk recipes

This method of treatment is aimed only at eliminating unpleasant symptoms: relieving pain and eliminating swelling.

This therapy begins with the use of thermal baths, which are made using simple sea salt. Feet should be immersed in a hot solution for half an hour, and then rinsed and wiped dry. This procedure is recommended to be carried out daily, preferably in the evenings. Treatment of Keller's disease using folk recipes can be combined with traditional medicine. But this can only be done with the permission of the attending physician.

Of course, type 2 disease requires more serious therapy to ensure complete immobilization of the distal parts of the injured limb. Traditional medicine in this case can only reduce the intensity of the pain syndrome. That is why, when the first alarming signs of pathology occur, it is necessary to urgently consult an orthopedist.

Surgery

In case of type 1 anomaly, during surgery two canals are made in the scaphoid bone, into which vessels subsequently grow and provide the necessary nutrition to the tissues. Usually, after surgery, the pain quickly subsides and does not return. During the rehabilitation period, the patient is recommended to undergo a course of massage, physiotherapeutic procedures and exercise therapy.

When Keller disease type 2 is detected, surgery is required much less frequently. Surgical intervention is necessary only when deforming osteoarthritis occurs. In such situations, bone growths are eliminated, and the head of the metatarsus is given a specific spherical shape. The entire bone cannot be resected, as this may cause the limb to lose significant support.

Preventive measures

As you know, any defect is always much easier to prevent than to treat. Prevention of Keller's disease in children and adults involves:

• correct choice of shoes;
• refusal of excessive physical activity;
• systematic examinations in medical institutions;
• timely treatment of various injuries;
• early diagnosis of problems associated with foot deformities.

Keller's disease is a fairly rare disease in which the structure of the bones of the foot is gradually destroyed, causing the foot to “blur”, losing its normal shape. Most often, this scourge affects children and adolescents; it is almost never diagnosed in adults.

ICD-10 code

Keller's disease belongs to the group osteochondropathy diseases, and the exact reasons for its appearance are not fully known. With this disease, spongy bone tissue begins to deteriorate: the bones and adjacent joints are deformed, microcracks form in them, and as a result the bone breaks up into smaller fragments. However, with timely and correct treatment, repair occurs with a high degree of probability: fragments of destroyed bone are absorbed, and it is restored thanks to the properties of spongy tissue.

Since the disease is diagnosed mainly in children, according to the international classification ICD-10 Keller's disease has the code M92: other juvenile osteochondrosis.

Depending on which bones are affected, the disease is divided into two types.

In this case, pathological processes affect the navicular bone, a flat bone located in the center of the foot. Basically, this diagnosis is given to preschoolers, most often boys 3-7 years old. As a rule, only one foot is affected (although sometimes both begin to collapse).

In type 2 disease, the small bones near the base of the fingers, the so-called metatarsal heads, are affected. In this form, the disease mainly affects teenage girls (11-15 years old).

Causes

The cause of degeneration and possible death of bone tissue is circulatory disorders, which is why the disease can be triggered by hormonal changes, excessive physical activity, injuries, sometimes even invisible, as well as incorrectly selected shoes. Sometimes the reason lies in heredity.

Particularly important choosing the right shoes for children: it must be of the appropriate size, with an elastic, dense sole and anatomical insoles. Due to rapid growth and insufficient bone density in the feet, children are more susceptible to the disease than adults.

Symptoms

Sometimes the disease can be asymptomatic, sometimes the pain is so insignificant that they do not pay attention to it, but there are signs that suggest the presence of Keller disease in children:

1. Complaints of pain in the leg during physical activity.
2. Lameness when walking.
3. The child tries to lean on the outside of the foot or stubbornly tries to lean on only one leg.

For both children and adults, common symptoms are:

• Swelling (not very pronounced) of the back of the foot.
• Pain, especially when walking or palpating the foot (central part or metatarsal bones).

Diagnostics

The main (and perhaps the only) option to determine Keller's disease is radiography, since even a thorough examination and questioning of the patient may not reveal the problem.

With type 1 disease, changes in the scaphoid bone are clearly visible on the pictures: areas of increased density are visible (they are darker), as well as deformation or even fragmentation of the bone. After treatment (or self-healing of the bone), both the tissue structure and the shape of the bone return to their normal values.

With Keller's disease type 2, there is compaction of the metatarsal heads, the distances between them increase, and fragmentation may also occur. As a rule, complete recovery almost never occurs: in this case, degenerative changes in the foot remain forever.

Treatment methods

Even without treatment the disease may go away on its own: the spongy structure tends to recover, but it recovers very slowly, and the foot may remain deformed. It’s definitely not worth letting the process take its course: according to statistics, about 6% of people who get sick become disabled.

Treatment is aimed at reducing the load on the foot, relieving pain, and improving blood supply to the joints. For this, various means are used, both traditional and folk. Surgical intervention is practiced extremely rarely, and only in advanced cases of type 2 disease.

Conservative treatment

First of all, they are appointed immobilizing procedures: a cast is applied to the foot, which fixes it in a stationary state, ensuring, on the one hand, the correct location of all the bones, and on the other hand, complete rest. The patient wears such a “plaster boot” for 1-1.5 months, then, if necessary, the procedure is repeated after a month.

To relieve pain, painkillers (analgesics) are used, to relieve local swelling - nonsteroidal anti-inflammatory drugs.

After immobilization, massage and electrophoresis are prescribed to improve blood supply to the foot and joint mobility. A set of specific exercises is required to perform.

In addition, it is necessary to take vitamin complexes with calcium and phosphorus to strengthen bones and better restore damaged areas.

For both adults and children, the treatment principle is the same; only the medications may differ: for children they are more gentle, “children’s”.

Folk remedies

Traditional methods for Keller's disease can in no case replace traditional treatment: they can only be used as an auxiliary therapy to relieve swelling and reduce pain, as well as to improve blood circulation in the feet.

For example, warm baths with sea salt help to relieve swelling, and cool (not higher than 37 degrees) decoctions of calamus rhizomes or currant and nettle leaves will help improve blood circulation.

Prevention

Like any disease, Keller's disease is easier to prevent than to treat. Preventive measures for adults and children should include:

1. Prevention and treatment of flat feet.
2. Selection of comfortable shoes, use of orthopedic insoles.
3. Consult an orthopedic specialist, especially if pain or swelling occurs.

For children, additional preventive measures are required, in particular, the absence of heavy loads on the foot until at least 7 years of age, as well as careful attention to the child’s injuries and complaints.