Kohler's Disease Research Articles

Osteochondrosis of the primary ossification center (Kohler's Disease) of the patella

Osteochondrosis of the primary ossification center (Kohler's Disease) of the patella

Rare radiograph finding: Kohler disease

Rare radiograph finding: Kohler disease

Foot pain in children and adolescents: a problem-based approach in musculoskeletal ultrasonography.

Various etiologies and risk factors contribute to foot pain in children and adolescents, including conditions such as Kohler's disease, Sever's disease, Iselin's disease, rigid flat foot, accessory navicular, Freiberg's disease, sesamoiditis, os trigonum syndrome, and more. High-frequency musculoskeletal ultrasonography can show both the bone surface and the surrounding soft tissue clearly from various angles in real-time, thereby providing a higher level of detail that is helpful for identifying the etiology of foot pain and monitoring disease progression compared with other imaging modalities. This review provides an overview of the epidemiology, pathophysiology, clinical manifestations and characteristic ultrasonographic findings of select foot pain conditions in children and adolescents.

Clinical report of microsurgical treatment of Kohler's disease

The conservative treatment for Kohler's disease will take several months, but some patients still have flatfoot and persistent pain. From October 2013 to July 2015, 3 children with Kohler's disease underwent navicular decompression and micro-circulation reconstruction surgery in our hospital. All the patients have received conservative treatment for more than 3 months and the effect was poor. X-ray showed the bone density of navicular increased significantly. All patients were followed up over 1 year. The 3 patients recovered well. VAS score decreased from 7.0 to 2.6 at 1 month after the operation. The pain symptom disappeared completely on 3 months after surgery. The density of navicular bone recovered to normal. Navicular decompression and micro-circulation reconstruction surgery may quickly improve the ischemic status of navicular bone, alleviate pain symptom and enable patients to resume normal activity as soon as possible.

Kohler's Disease Case Report: Treatment with Regenerative Distraction Arthroplasty Technology

Kohler’s disease is a rare condition which in most cases responds to non-operative management. This report presents an unusual case where the thinning of the navicular resulted in a symptomatic pathological fracture. The patient was treated initially by Open Reduction and Internal Fixation (ORIF). The fracture united and the patient’s symptoms initially resolved. Three years later, symptomatic peri-navicular arthritis developed which was treated by distraction arthroplasty leading to symptom resolution. This case presents a novel solution which otherwise would have resulted in a complex midfoot fusion in a young patient. The methodology demonstrates the utility of new technological advances in joint regenerative technology.

The Utility of Tc-99m Hydroxydiphosphonate Single-Photon Emission Computed Tomography/Computed Tomography in Symptomatic Kohler's Disease.

Kohler's disease (KD) is a rare disorder of the foot in children where there is avascular necrosis of the navicular bone (NB). It presents with pain and limping and is often misdiagnosed as an infection. However, by adding single-photon emission computed tomography-computed tomography (SPECT-CT) of the foot, the lesion is localized to the NB, leading to the diagnosis of KD. We report the case of a 6-year-old boy with limping and foot pain, who underwent a bone scan using Tc-99m hydroxydiphosphonate and SPECT-CT of the feet. SPECT-CT was necessary not only to localize the exact site of the pathology in an area with small bones but also to confidently reach the diagnosis of KD and proceed with the correct management plan.

Kohler disease: A rare under diagnosed cause of pediatric foot arch pain and limping

Kohler disease: A rare under diagnosed cause of pediatric foot arch pain and limping

COMPARATIVE MODELING FOR SACCHAROMYCES CEREVISIAE RAD56 USING SWISS-MODEL, I-TASSER, AND PHYRE2

Objective: RAD56 is a protein its causes pathological conditions of Kohler disease, Mueller-Weiss syndrome, which leads to hindfoot pain. RAD56 is considered an impressive drug target for various illnesses. The experimental 3D structure of RAD56 is not available. Therefore, the present study aims in developing a homology model using 3 different software and evaluate the best model. Methods: The developing homology modeling on RAD56 is built utilizing three diverse software’s to be specific Swiss-Model, I-Tasser, and Phyre2. All the predicted models were analyzed and approved by PROCHECK, PROSA, Errat, and Verify_3D. Results: Homology Modeling anticipated from Swiss-Model appeared best comes about with 88.6% of the buildups within the most favorable locale, 11.2% within the permitted region, 0.6% within the liberally permitted locale, and 0.2% within the refused locale. PROCHECK, PROSA, Errat, and Verify_3D, too, affirmed the same. Conclusion: Homology Modeling was created for RAD56 utilizing Swiss-Model, I-Tasser, and Phyre2. The models created were validated utilizing PROCHECK, PROSA, Errat, and Verify_3D. This investigation approved the homology model created by is best Swiss-Model 88.6, vigorous as well as solid sufficient to be utilized for future pondering.

Aseptic (avascular) bone necrosis in the foot and ankle.

Aseptic necrosis may be defined as a group of diseases that have bone necrosis as a common denominator. They usually appear in the epiphyses and in the carpal and tarsal bones. They generally appear during a growth period and principally at those skeletal points subjected to particular stress.In Müller–Weiss disease in the advanced stages, talonavicular-cuneiform arthrodesis, with or without back foot correction, is the best surgical option.In Freiberg–Kohler disease, treatment can be conservative and we can maintain the head of the metatarsal by performing a joint debridement of the metatarsophalangeal joint with removal of loose bodies. The lateral upper and lower faces of the distal extremity of the metatarsal are resected, preserving the joint cartilage that in its centre portion is always healthy. The osteophyte border that may be present in the phalanx is resected.Most frequently, avascular necrosis (AVN) of the talus is a sequel to talar fractures, with the possibility that the AVN increases with the severity of the trauma and the damage associated with the already precarious blood supply of the talus.The surgical treatment used for sesamoid AVN is partial excision of the affected bone.Cite this article: EFORT Open Rev 2020;5:684-690. DOI: 10.1302/2058-5241.5.200007

Kohler's Disease: Acute Foot Pain and Limping in Pediatric Emergency Department

Kohler’s disease is a rare cause of limping in children which is hypothetically related with impaired blood supply of navicular bone by the compression of other tarsal bones. The clinical manifestations are pain and swelling in the midfoot and limping with typical steps on the lateral aspect of affected foot. As it is an elusive entity for physicians, the lack of clinical suspicion leads to utilization of advanced diagnostic tools and delayed diagnosis. Here we present a case of Kohler’s disease as a 5 years-old girl with acute foot pain and limping.

Adult Tarsal Scaphoiditis: Management

Adult tarsal scaphoiditis or Mueller Weiss disease is a rare condition characterized by collapse of lateral half of the navicular bone. It is a spontaneous adult onset osteonecrosis of navicular bone with unclear etiology. Mueller Weiss disease is not sequelae to childhood onset Kohler's disease. Middle-aged women complain of midfoot and hindfoot pain. A detailed clinical and plain weight-bearing radiograph of foot is often diagnostic. The condition is graded using Maceira classification based on the deformity on lateral radiographs. Numerous surgical options are described for the management but no gold standard. We are presenting three patients, one with bilateral feet involvement, all in Maceira stage III deformity treated with double arthrodesis (talonavicular-cuneiform and calacaneocuboid) and autologous bone grafting achieving solid fusion and good functional outcome. How to cite this article: Simon R, Sukesh AN, Jose DP. Adult Tarsal Scaphoiditis: Management. J Foot Ankle Surg (Asia Pacific) 2020;7(1):21–23.

Is Attention Deficit Hyperactivity Disorder a Risk for Kohler's Disease? Osteonecrosis of Navicular Bone of Foot

Abstract We present a pediatric case report of foot pain due to Kohler's disease. We discussed the etiology and treatment of Kohler’s Disease of a 5-year-old boy who had Attention Deficit Hyperactivity Disorder in this case report. Our goal is elucidate the etiology of these cases and their relationship with behavioral disorders. Key Words: Osteonecrosis of Navicula; Kohler Disease; Attention Deficit Hyperactivity Disorder (ADHD), Trauma

Kohler's Disease of the Tarsal Navicular in a 7-Years-Old Child

Kohler's Disease of the Tarsal Navicular in a 7-Years-Old Child

Complete spontaneous avascular necrosis of the adult navicula associated with Mee's growth arrest lines of the great and second toenails

Spontaneous total avascular necrosis of the tarsal navicula has been well documented in children (Kohler's disease) but is uncommon in adults where partial necrosis is usually seen after trauma or in Müller-Weiss disease. A case of spontaneous complete navicular osteonecrosis in a 46 year old female is described; she had accompanying Mee's leuchonychial lines in the toenails of the great and second toes only; the lines resolved after 9 months. She has been treated with an excision of the navicula and interpositional iliac crest bone graft talo-cuneiform fusion with resolution of her pain. It is postulated that the combination of the Mee's lines and avascular necrosis of the navicula indicates an occlusion of the dorsalis pedis in a predisposed individual.

Recognition and Management of Müller-Weiss Disease

Müller-Weiss disease (MWD) is an uncommon condition of unclear etiology, characterized by compression of the lateral aspect of the tarsal navicular bone. It presents with chronic mid and hindfoot pain, mostly in middle-aged females. It does not represent persistence of Kohler's disease, which is self-limiting and resolves completely in childhood. A total of 12 patients with 19 affected feet, seven of whom had bilateral involvement, presented to a single foot and ankle surgeon over a 10-year period. Diagnosis of MWD was based on radiographic appearances demonstrating compression of the lateral part of the navicular. Affected feet were graded using Maceira classification. The cohort comprised four males and eight females with a mean age of 57.9 years. Only one patient had previously been a manual worker. Mean duration of symptoms was 5.2 years. Of the seven patients who underwent surgery for symptoms related to MWD, five had a triple arthrodesis, one had triple arthrodesis combined with naviculo-cuneiform fusion, and one had a pantalar arthrodesis for associated varus ankle osteoarthritis. Solid union was achieved in all cases. We propose that MWD is much more common than previously reported and did not find conditions of extreme environmental stress or poverty in our patients. We advocate surgical management of the condition by triple arthrodesis and extend it to include a naviculocuneiform fusion whenever indicated according to CT findings.

Kohler's disease

We present a pediatric case report of foot pain due to Kohler's disease.

Osteochondroses and Apophyseal Injuries of the Foot in the Young Athlete

With an increase in involvement in sports activities by children and adolescents, there has been a concomitant increase in both acute and overuse injuries. The pediatric skeleton lends itself to injuries unique to the young athlete, including various apophysites and osteochondroses. It is important for primary care and sports physicians treating the athlete to be aware of normal and abnormal variations in the pediatric skeleton, as well as common sites of injury in the pediatric foot. This article provides an overview of some of the most common skeletal foot injuries in the pediatric athlete, including Freiberg's infraction, Sever's disease, Kohler's disease, os navicularis, and Iselin's disease.

King Tutankhamun, Modern Medical Science, and the Expanding Boundaries of Historical Inquiry

TUTANKHAMUN, BETTER KNOWN AS KING TUT, RULED ancient Egypt from 1333 to 1324 BC, during the 18th dynasty (circa 1550-1295 BC) of ancient Egypt’s New Kingdom (circa 1550-1070 BC). His brief reign, youthful visage, and premature death, as well as the rediscovery of his remains and tomb in 1922, have fascinated Egyptologists and other historians alike for decades. Over the years, many scholars have offered a wide variety of explanations for his early demise as well as the seemingly androgynous appearance of his face and gynecomastia portrayed in sculptures and other relics. These diagnoses have included Marfan syndrome, Wilson-Turner X-linked mental retardation syndrome, Frohlich syndrome (adiposogenital dystrophy), Klinefelter syndrome, androgen insensitivity syndrome, aromatase excess syndrome in conjunction with sagittal craniosynostosis syndrome, and Antley-Bixler syndrome or one of its variants. After a series of radiographs taken of Tutankhamun’s mummy in 1968 suggested signs of trauma to the back of the head and an unhealed broken leg, armchair pathologists began suggesting that Tutankhamun’s death was caused by his falling from a chariot, getting kicked in the head by a large beast, septicemia or fat embolism secondary to a femur fracture, or, most sensationally, being murdered by either a blow to the back of the head or poisoning. More recently, an advertisement with the headline “Murder of King Tut Solved” in the October 1, 2009, issue of USA Today announced a new book by a best-selling mystery writer and a historian. Echoing the theories of many others, these authors suggest that the boy pharaoh married his younger sister, Ankhensenamun to produce a male child. The marriage produced no heirs but inspired an imaginative plot— specifically, the queen, a villainous general, and an evil advisor murdered Tutankhamun so they could assume control of the kingdom. Such diverse musings serve as proof of the most enjoyable aspect of retrospective diagnoses: there is always room for debate and, in the face of no definitive evidence, room for new theories and claims. But as Hawass and colleagues demonstrate in their study of King Tutankhamun’s family in this issue of JAMA, the legion of Tutankhamun admirers might be well advised to reconsider several existing theories. Between September 2007 and October 2009, Hawass et al, from Egypt, Germany, and Italy, independently examined 11 royal mummies believed to be from King Tutankhamun’s immediate lineage (circa 1410 to 1324 BC) and another 5 royal mummies from an earlier period (circa 15501479 BC). The objective was to determine the familial relationship of these royal family members and test the mummies for evidence of murder, genetic disorders, and infectious diseases. Unlike the previous hypotheses about Tutankhamun’s death and medical history, this investigation was based on unfettered access to the actual mummies. Using partial Y-chromosomal information, Hawass et al constructed the most plausible 5-generation pedigree to date, whereby Yuya and Thuya are established as the greatgrandparents of Tutankhamun; Pharaoh Amenhotep III and KV35 elder lady (Queen Tiye) are his grandparents; and KV55 male (most likely Akhenaten) and KV35 younger lady are siblings as well as Tutankhamun’s parents. Settling the question of Tutankhamun’s supposed gynecomastia is not possible, because most of the mummy’s chest wall is missing. It is also difficult to assess such abnormalities among the other males in the study because of the mummification process. Nevertheless, the morphological and radiological examinations did not reveal evidence of a feminine physique, leading the authors to suggest that the artistic or “beautified” style of artifacts and portraits of Tutankhamun’s era may have left behind the wrong impression for 20thand 21st-century observers. Although no evidence was found to confirm a diagnosis of either Marfan or Antley-Bixler syndromes, Tutankhamun did have juvenile aseptic bone necrosis of the left second and third metatarsals, which may be consistent with Kohler disease II or Freiberg-Kohler syndrome. More-

Osteonecrosis in the Foot

Osteonecrosis, also referred to as avascular necrosis, refers to the death of cells within bone caused by a lack of circulation. It has been documented in bones throughout the body. In the foot, osteonecrosis is most commonly seen in the talus, the first and second metatarsals, and the navicular. Although uncommon, osteonecrosis has been documented in almost every bone of the foot and therefore should be considered in the differential diagnosis when evaluating both adult and pediatric foot pain. Osteonecrosis is associated with many foot problems, including fractures of the talar neck and navicular as well as Kohler's disease and Freiberg's disease. Orthopaedists who manage foot disorders will at some point likely be faced with the challenges associated with patients with osteonecrosis of the foot. Because this disease can masquerade as many other pathologies, physicians should be aware of the etiology, presentation, and treatment options for osteonecrosis in the foot.

Kohler Disease: Diagnoses and Assessment by Bone Scintigraphy

Limping is a frequent occurrence in children and may be caused by various conditions, including trauma, inflammation, infection, and malignancy. Nontraumatic avascular necrosis of the tarsal bones should be included in the differential diagnosis. Accumulated data have supported the superiority of bone scans to radiography in the early diagnosis of avascular necrosis. Bone scintigraphy is a useful tool for investigating pain when symptoms, laboratory examinations, and radiography do not point to a specific diagnosis. In the early phase of disease, bone scans may demonstrate decreased tracer uptake (photopenic region), subsequently a hot area is seen during the reparative process. Although magnetic resonance imaging has important implications in the diagnosis of avascular necrosis, bone scintigraphy with its ready availability has a significant role as a primary tool in the evaluation of a limping child.