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    Go to the top of the page   ID: 20040206232311 ( 524 times read ) Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    This case was evaluated as very interesting (Grade 8.6).

     
    Kohler's Disease II, Bilateral Freiberg-Kohler Disease
    Ina Sorge. Kohler's Disease II, Bilateral Freiberg-Kohler Disease. PedRad [serial online] vol 4, no. 2.
    URL: www.PedRad.info/?search=20040206232311


     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Ina Sorge (Kinderradiologie/Uni Leipzig)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    13 Years  

     
     Pediatric Radiology CasesGender:

    Female  

     
     Pediatric Radiology CasesRegion-Organ:

    Leg-Bones  

     
     Pediatric Radiology CasesMost likely etiology:

    circulatory  

     
     Pediatric Radiology CasesHistory:

    Pain initially in the left foot; a few months later also in the right foot, particularly on exertion. Slight swelling, pain on pressure.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Aseptic bone necrosis are seen in children along with cartilage ossification defects throughout growth or throughout increased exertion. A cause may be passing intraossic vascularization disturbances through a mycotic-embolic vessel obstruction, bland infections, trauma, vessel spasms, vegetative dysregulations or vessel trauma. Constitutional and alimentary factors seem to play a role as well. The infestation can be unilateral or bilateral.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Left foot, October 2000: subchondral density and fragmentation of the 2nd metatarsal bone with undamaged joint.






    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Left foot, November 2000: Flattening of the joint.






    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Right foot, September 2001: Barely noticeable flattening and subchondral density of the head of the 2nd metatarsal.






    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Right foot, December 2001: 3 Months after the first image shows an obvious flattening of the joints, beginning fragmentation.






    X-Ray 5 <- view X-Ray 5

    X-Ray 5: Right foot, October 2002: 1 year after disease began. Fragmentation, Break of the joint.






    X-Ray 6 <- view X-Ray 6

    X-Ray 6: January 2003: Late stage disease on both sides with deformation of the joint and beginning osteophytic structures as seen in a beginning secondary arthrosis.


     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    Total constellation (Consens)  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    none  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Freiberg-Kohler's disease is the only bone necrosis that is more often seen in girls than in boys.

    II: partially detached osteochondral lesion

    III: completely detached, non-displaced fragment

    IV: detached and displaced fragment

    There are 4 stages:
    1. Initial stage with cartilaginous edema and joint effusion. The X-ray is still unnoticeable, in MRI bone marrow edema.

    2. Condensation-density of bone structures in hypermineralization of necrotic bony trabecula. In the X-ray it is already seen, in MRI double-line sign.

    3. Fragmentation with deformity of joint structures. Up until this stage, 2 or 3 years since begin of disease may have passed.

    4. Repair with replacement of necrotic tissue with the new bone substance. Requirement: Revascularisation

    An early diagnosis is possible , next to MRI, with the 3-phase skeletal szintigraphy. Avascular bone areas are known as so-called "cold-spots".

    Treatment:
    Conservative: decompression and increased circulation. bed rest, no sports, decompressing wraps, support insoles. Antiphlogistical, hyperemic and physical therapy. Prostaglandin analogs such as Ilomedin (Schering).

    Surgical: Drilling to result in pressure decompression and increased revascularization. Nailing/Pinning, correction in Freiberg-Kohler as, for example, open-flap osteotomies in the later stages with pain and deformation.

    The course of the disease is dependent on how fast vessels revascularize the area. An early diagnosis is therefore of great importance.  

     
     Pediatric Radiology CasesComments of the author about the case:

    The images show a phasic course of an osteonecrosis. On the right side Stage I (barely noticeable changes in X-Ray) up to a defect healing about 3 years later.  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    1. Medline: Medline
    G.Petje, C.Radler, N.Aigner, G.Kriegs-Au, R.Ganger, F.Grill
    Aseptische Knochennekrosen im Kindesalter
    Der Orthopäde 2002-31:1027-1038
     

     
     Pediatric Radiology CasesKeywords:

    aseptic bone necrosis, osteonecrosis, avascular necrosis, Kohler's Disease II, Freiberg-Kohler, avascular bone necrosis, child, childhood, pediatric radiology  

     
     Pediatric Radiology Cases Cite this article:

    Ina Sorge. Kohler's Disease II, Bilateral Freiberg-Kohler Disease. PedRad [serial online] vol 4, no. 2.
    URL: www.PedRad.info/?search=20040206232311  

     
     Pediatric Radiology Cases Read similar articles: with corresponding keywords
    in the same field: Leg-Bones
    or in the region: Leg
    or in the tissue/organ: Bones
    or with the etiology: circulatory
     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] View all modalities [ All ]   
     
    Kohler's Disease II, Bilateral Freiberg-Kohler Disease
    Ina Sorge. Kohler's Disease II, Bilateral Freiberg-Kohler Disease. PedRad [serial online] vol 4, no. 2.
    URL: www.PedRad.info/?search=20040206232311


     

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    Kohler's Disease II, Bilateral Freiberg-Kohler Disease
    Other cases by these authors:

    Search Ina Sorge in Medline Ina Sorge (8)   

    Kohler's Disease II, Bilateral Freiberg-Kohler Disease  
     
    Kohler's Disease II, Bilateral Freiberg-Kohler Disease
    Ina Sorge. Kohler's Disease II, Bilateral Freiberg-Kohler Disease. PedRad [serial online] vol 4, no. 2.
    URL: www.PedRad.info/?search=20040206232311


     

    Which diagnosis have other collegues guessed?


    • Osteosarcoma (both sides)
      Votes: 0 (0 %)


    • Köhler's Disease I
      Votes: 7 (46 %)


    • Köhler's Disease II
      Votes: 7 (46 %)


    • Thiemann's Disease
      Votes: 0 (0 %)


    • Iselin's Disease
      Votes: 1 (6 %)



        Total answers: 15

     
    Kohler's Disease II, Bilateral Freiberg-Kohler Disease
    Ina Sorge. Kohler's Disease II, Bilateral Freiberg-Kohler Disease. PedRad [serial online] vol 4, no. 2.
    URL: www.PedRad.info/?search=20040206232311


     

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    How interesting was this case for you?
    (10 = most interesting || 1 = less interesting)
    This case was evaluated as very interesting (Grade 8.6).

     
    Kohler's Disease II, Bilateral Freiberg-Kohler Disease
    Ina Sorge. Kohler's Disease II, Bilateral Freiberg-Kohler Disease. PedRad [serial online] vol 4, no. 2.
    URL: www.PedRad.info/?search=20040206232311


     




    Discussion >> Write Comment <<


    Kohler's Disease II, Bilateral Freiberg-Kohler Disease:  frieberg kohler disease
    (Barbara | 28.08.10)


    I've had this prob since I was 14. I was a sprinter and thought I had an injury, doctors thought it was a cyst did an exploratory, long recovery thank you very much, and found nothing. I suffered till I was 28 when I finally decided to go to a specialist, an orthopedic surgeon who told me I had Frieberg Kohler disease said it happens mostly to 14 year old girls either in their foot or hip. A bone degenerative disease. I have it in my right foot the 3-4 toe. Pain doesn't describe it adequately. I wore the high hills all my 20's and now I have a terrible time finding shoes with style that won't kill me. I was told there was nothing that could be done. No prothesis available and just have to live with it. I would love to hear if there is actually treatment. Please let me know.


      Morbus Köhler II, Morbus Freiberg-Köhler (beidseitig):  aseptischer Morbus Köhler
      (Mary Brauckhoff | 12.07.10)


      Hallo erstmal, bin heut zum ersten Mal auf der Seite, da wir heut norgen von unserem Orthopäden für meine 9-jährige Tochter diese Diagnose bekommen haben.Erhoffe mir von Ihnen einige Informationen über Therapieerfolge der Krankheit.Meine Tochter hat auch Einlagen verchrieben bekommen, aber vielleicht gibt es ja noch irgendein Medikament,welches den Knochenaufbau unterstützen bzw.den Knochenabbau verzögern oder verhindern kann.Wäre für Infos sehr dankbar.Liebe Grüße!M.Brauckhoff


        Morbus Köhler II, Morbus Freiberg-Köhler (beidseitig):  Köhler 2
        (Lisa | 01.06.09)


        Hey! I got Köhler in my left foot when I was 12 and had to go with it for 4 years. Then I told the doctors to do something. I had a surgery and now I'm fine. Thats 7 years ago. I can't move the toe as much as the others but it's okey. No more pain. So my tip is, have the surgery!


          Morbus Köhler II, Morbus Freiberg-Köhler (beidseitig):  Morbus Köhler 1^
          (Kirchner | 15.10.08)


          Mein SOhn 8 Jahre alt leidet seit fast 1 Jahr unter dieser Krankheit.
          Am anfang dachten wir das wir es nach ca 4 monaten schmerzen, Giosschiene und gehstützen alles hinter uns gebracht hätten , leider leidet er jetzt mittlerweile wieder sehr darunter. Jetzt heisst es wieder 3 Wochen Gehstützen:-(
          Das letzte MRT zeigte einen befund der in ordnung war. Jetzt ca 2-3 monate spätzer fängt es wieder an. Langsam weiss ich echt nihct merh weiter es ist nicht nur eine belastung für ihn sonder für die ganze familie zur schule hin in die klasse helfen , ranzen tragen , treppen hoch tragen
          ich hoffe das es sich nicht noch so schlecht entwickeln wird.



            Morbus Köhler II, Morbus Freiberg-Köhler (beidseitig):  morbus köhler II
            (Marliese Rappolder | 05.05.08)


            Hallo, vielleicht kann mir jemand helfen. Ich habe seit November 2007 Morbus Köhler II, wurde auch gleich festgestellt. Die Therapie sind Einlagen und Schuhe mit Sohlen, die die Abrollbewegung des Fusses richtig machen. Das ist alles. Ich möchte mich damit aber nicht abfinden. Bin 45 jahre alt und gehe gern wandern, spazieren und walken. Was gibt es für Möglichkeiten die Durchblutung des Knochen wieder intakt zu setzen


              Morbus Köhler II, Morbus Freiberg-Köhler (beidseitig):  Morbus Köhler II
              (Kerstin Stracke-Weiß | 10.08.07)


              Unsere Tochter ist seit über 1 Jahr an Morbus Köhler II erkrankt und ich würde gerne wissen, ob es inzwischen irgendwelche erfolgsversprechenden Therapien gibt. (Ilomedin, Einlagen, Schonung bereits versucht, aber leider nur mit temporärem Erfolg). Gibt es die Möglichkeit mit anderen betroffenen Eltern in Kontakt zu treten?
              Vielen Dank im voraus!



                re: Morbus Köhler II, Morbus Freiberg-Köhler (beidseitig):  Morbus Köhler II
                (Malaika Eschbaumer | 13.08.07)


                Ich werde am 14. 08. operiert und kann ihnen gerne Informationen zukommen lassen, wie es mir nach der OP, bzw. wenn hoffentlich alles "verheilt" ist, geht. Ich habe Morbus Köhler II seit bestimmt 3 Jahren, aber erst der 4. Orthopäde hat es bei mir erkannt. - Liegt vielleicht auch daran, dass ich schon 26 bin und nicht ins "gewöhnliche Erkrankungsalter" falle. Melden Sie sich einfach wieder! (Und wünschen Sie mir Glück für Dienstag!) :)


                  re: Morbus Köhler II, Morbus Freiberg-Köhler (beidseitig):  Morbus Köhler II
                  (Kerstin Stracke-Weiß | 13.08.07)


                  Liebe Frau Eschbaumer,
                  ich finde das sehr nett, dass Sie sich auf meine Anfrage hin gemeldet haben und wünsche Ihnen für morgen alles erdenklich Gute! - Ja, ich wäre an einem Austausch herzlich interessiert, insbesondere in welchem Spital und durch wen die OP vorgenommen wurde.
                  Alles Gute!
                  Kerstin Stracke-Weiß
                  P.S. Kann ich Sie auch direkt kontaktieren?



                    Find the right diagnosis!:  fever
                    (yakup | 21.02.10)


                    have is she fever? vomiting and nausea?


                      re: Find the right diagnosis!:  fever
                      (Angela Gregory | 22.02.10)


                      Thank you for your comment/ question.No fever or nausea and vomiting was reported. Inital presentation was sore throat and dysphagia. On representation she still remained apyrexial however there was a raised WBC and CRP.


                    re: Morbus Köhler II, Morbus Freiberg-Köhler (beidseitig):  Morbus Köhler II
                    (Malaika Eschbaumer | 18.09.07)


                    Hallo Frau Stracke-Weiß,
                    ich hab Sie nicht vergessen! Die OP ist prinzipiell gut verlaufen (ich hatte nur eine Lokalanästhesie). Ich habe einen Lauf-gips bekommen, hatte also keine Krücken, und bin jetzt schon wieder eine Woche ohne Gips unterwegs. Der Fuß siehr immer noch nicht "normal" aus (die Zehen stehen noch hoch, der Fuß ist immer noch schmal, die Muskel haben sich noch nicht ganz zurückgeblildet usw.), wenn ich barfuß laufe, kann ich auch noch immer nicht ohne Schmerzen auftreten.
                    Nochmal zur OP: Der Arzt hat das kranke Gewebe entfernt, das Köpfchen quasi "abgeschmirgelt" und dann den Knochen vom 2. und 3. Zeh durchgesägt und nach hinten versetzt (und in den Zwischenraum jeweils einen Nagel eingesetzt, der auch drin bleibt. Diese Art der OP heißt (glaube ich)Weil-Osteopathie. Der Arzt war kein besonderer Fachmann, aber da er der erste und einzige war, der Morbus Köhler II bei mir erkannt hat, hatte ich Vertrauen zu ihm und habe mich auch direkt bei ihm (in der Praxis) operieren lassen. Ich studiere in Wien und der Orthopäde (Dr. Oppolzer) hat seine Praxis auch hier.
                    Je nachdem wie alt sie ist, kommt eine OP für ihre Tochter wahrscheinlich nicht in Frage . . . bei mir war es (nach einer versuchten Stosswellentherapie) eigentlich der letzte Schritt. Mein Orthopäde meinte, dass sich sonst das nekrotische Gewebe im Laufe der Zeit ausbreiten könnte.
                    Ich hoffe, ich habe Ihnen ein bißchen weitergeholfen! Ob sich durch die OP wirklich etwas verbessert hat, kann ich noch nicht sagen. Falls Sie noch Fragen haben, hier meine Email-Adresse: malaikaeschbaumer@web.de
                    Viele Grüße, Malaika Eschbaumer




                    ( | )





                    Kohler's Disease II, Freiberg-Kohler (both sides):  still suffering from Freiberg-Kohler
                    (Anne Connell | 11.07.07)


                    Like Angelika Selwesiuk, I was diagnosed with this syndrome in my left foot several years ago, was treated, but the pain persists and is now also in my right foot. I was diagnosed with Freiberg-Kohler 2 years ago when I was 17, after several years of competetive running. I had to quit running due to the pain and was in a leg cast for 8 weeks, but the pain has never gone away, and has recently started to get much worse. I have also lost all mobility in my 2nd and 3rd toes of my left foot. What else can I do to help this finally heal or ease the pain? Has anyone heard of any surgery that has helped other people with this problem?
                    Thank you.




                      ( | )





                        re: Kohler's Disease II, Freiberg-Kohler (both sides):  still suffering from Freiberg-Kohler
                        (Ann Connel | 26.03.08)


                        Hi, this is Anngelika Selwesiuk, the surgery was suggested to me couple of times but I refused to have it. I was just scared of having it, because none of the doctors gave my a high percentage of improovement after the surgery. I even heard from one of them that:"if you want to have it you can, but don't believe you will be pain free afterwards." I lost the mobility in one of my toes as well; however, I kind of learned how to manage the pain. I try to keep my feet in warm water mixed with salt as often as posible. I also had a powdered medication that you can disolve in water, but I don't remember the name of it. It really helped.


                        X-Ray: Kohler´s Disease II, Freiberg-Kohler (both sides)
                        (Angelika Selwesiuk | 07.06.06)


                        I'm 22 years old girl, and I'm suffering from Kohler's II disease for about 3 years. My doctor keep telling me that this process should stop by now. What is happenning now I'm starting to feel the pain in my second foot. My questions are: what can I do to stop it, are there any treatments or medicines that might help me, how far this disease can go an how big demage can it do to me. Any informaions I can get would be helpful. Thak you!


                          re: X-Ray: Kohler´s Disease II, Freiberg-Kohler (both sides)
                          (Roland Talanow | 14.06.06)


                          As to my knowledge Kohler's disease becomes symptomatic in an earlier age than you described. (But there are always esceptions, of course.)

                          A weightbearing below-the-knee cast is recommended for a total cast time of approximately 6-8 weeks. In mild cases, soft arch supports may be the only treatment necessary. In treated patients the symptoms may last for less than 3 months. If untreated, the symptoms may last for 15 months. In case the pain persists after a 6-week period of casting, a new cast should be applied for 6 supplementary weeks. If pain still persists one should take other causes of foot pain in consideration, like talar coalition or an accessory navicular, etc. An orthopedic specialist should be the right contact person for more indepth information and consultation.

                          Sincerely,
                          Roland Talanow, MD. PhD



                          Kohler's Disease II, Freiberg-Kohler (both sides):  Kohler's Disease
                          (Martina Paetzel | 01.03.04)


                          Just a question/comment to the treatment of Kohler's disease: I thought that a cast during inital illness is recommended for patients who have this disease. What do others think?

                          Why is it called Freiberg-Kohler's disease in the title? I thought that these were two different diseases. Kohler: avascular necrosis of the navicular bone; Freiberg: avascular necrosis of a lesser metatarsal head with infraction (caused by trauma).



                            re: Kohler's Disease II, Freiberg-Kohler (both sides):  Kohler's Disease
                            (Roland Talanow | 05.03.04)


                            Dear Martina Paetzel,
                            to your second question:

                            Freiberg-Kohler Disease is a spontaneous aseptic epiphyseal necrosis of the head of the 2. and (less often) the 3. and 4. metatarsal bone (especially on the right side at females in the youth). Symptoms: swelling, local pain, later eventually deformation of the regarding basic joint.

                            I hope this helped.



                              re: Kohler's Disease II, Freiberg-Kohler (both sides):  Kohler's Disease
                              (Ina Sorge | 06.03.04)


                              Dear Martina Paetzel,

                              you`re right: In the early stage of the illness several measures are recommended to reliev the bone: for example plaster casts.
                              The M.Freiberg-Köhler is also known as Köhler-II-disease- to differ from Köhler-I-disease, wich is the avasculare necrosis of naviculare bone.
                              With greetings
                              Ina Sorge








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