Kohler's disease


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Related to Kohler's disease: Freiberg's disease, King Tut, Kienbock's disease

osteochondritis

Orthopedics Inflammation of bone and joint surfaces–usually aseptic; note: A legacy of the German school of medicine was eponymic immortalization of osteochondritis in each joint
Osteochondritis eponyms
Freiberg's disease–metatarsal head
Haglund's disease–calcaneus
Köhler's disease–tarsal-navicular bones
Legg-Calve-Perthes disease–femoral head
Osgood-Schlatter disease–tibial tubercle
Panner's disease–humeral head
Sinding-Larsen-Johannson disease–patella
Thiemann's disease–metacarpal and metatarsal bones
Wegner's disease–osteochondritis with epiphyseal separation–congenital syphilis

Kohler's disease

1. OSTEOCHONDRITIS of the SCAPHOID bone of the foot. A condition affecting children and adolescents. There is a defect in the blood supply to the bone, from compression of the foot arch, leading to central bone death (necrosis). Weight-bearing must be avoided during the active stage of the disease, but spontaneous healing occurs.
2. Osteochondritis of the head of the bone in the palm articulating with the forefinger (second metatarsal bone). (Alban Kohler, 1874–1947, German radiologist).
Kohler's disease aseptic necrosis of navicular; presentation of osteochondritis affecting navicular ossification centre, classically in young boys aged between 2 and 9 years; presents as vague pain and perhaps swelling in area of navicular, with later navicular collapse (when it appears as a flat disc on lateral radiograph of foot); treatment includes rest and supportive strapping during acute phase, and orthoses in later stages (see Table 1and Table 2)
Table 1: Classifications of osteochondritis in the lower limb
Criterion 11. OC of the primary articular epiphysis (e.g. Freiberg's disease of the metatarsal head; Kohler's disease of the navicular)
2. OC of the secondary articular epiphysis (e.g. osteochondritis dissecans of the talus)
3. OC of the non-articular epiphysis (e.g. Osgood-Schlatter disease of the tibial tuberosity; Iselin's disease of the styloid process of the fifth metatarsal)
Criterion 21. Crushing apophysitis (e.g. Freiberg's disease) where the pressure of the base of the adjacent phalanx causes an 'eggshell fracture' of the affected metatarsal head
2. Traction or distraction apophysitis (e.g. Sever's disease; Iselin's disease; Osgood-Schlatter disease) where traction at the tendon insertion distracts a secondary centre of ossification from the body of the calcaneum, fifth metatarsal or tibia respectively
3. Fragmentation apophysitis (e.g. osteochondritis dissecans) in which the cortical bone overlying the enchondral defect fractures and separates to create a loose body within the joint
Two criteria may be used to classify osteochondritis:
• criterion 1 relates to the anatomical location of the enchondral ossification defect
• criterion 2 relates to the effects on the diseased bone brought about by the local forces that act on the bone.
Table 2: Presentations of osteochondritis/osteochondrosis in the leg and foot
OCSite affectedTypeAge of onset (years)
Blount's diseaseProximal tibial epiphysisUnderdevelopment of medial epiphysis1-3; 6-13
Buschke's diseaseCuneiformsOssification anomaly11-15
Freiberg's diseaseSecond/third metatarsal headCrushing OC12-18
Iselin's diseaseBase of fifth metatarsalTraction apophysitis11-15
Kohler's diseaseNavicularCrushing OC3-7
Legg-Calve-Perthe diseaseCapital femoral epiphysisTrue OC2-16
Osgood-Schlatter diseaseTibial tuberosityTrauma-related11-15
Osteochondritis dissecansTalar dome
Lateral femoral condyle of knee
Osteonecrosis12-18
Sever's diseaseCalcaneal apophysisTraction apophysitis10-14
Sinding-Larson-Johansson diseasePatellaTraction apophysitis10-14
Treve's diseaseSesamoids (1 MTPJ)True OC15-20

1 MTPJ, first metatarsophalangeal joint.