Köhler-Albau's disease

Classification according to ICD-10
M92.6	Juvenile osteochondrosis of the tarsus - navicular bone
ICD-10 online (WHO version 2019)

The Köhler disease is the aseptic osteonecrosis of the navicular (scaphoid of the tarsus) in children and adolescents. The rare occurrence in adults is known as Müller-Weiss syndrome .

Clinic, diagnostics and differential diagnostics

Köhler's disease I in an 8-year-old girl, normal opposite side

There is load-dependent pain in the metatarsus. Clinical examination reveals tenderness and occasional swelling over the navicular bone. The x-ray shows a disc-shaped narrowing and an increasing bone density in the navicular bone . A clod-like disintegration of the bone is possible. There is also a widening of the joint space between the talus and the navicular bone. The differential diagnoses include a post-traumatic vascularization disorder, a tumor, an inflammation, and a bipartite navicular bone .

If, on the other hand, the clinical symptoms are absent and the structure of the navicular bone is only noticeable in the X-ray image, there is usually a harmless standard variant ( ossification variant )

Therapy and prognosis

In the case of acute pain, immobilize in the lower leg cast and relieve the pressure for 8 to 12 weeks, then insoles to support the longitudinal arch. Usually a restitutio ad integrum takes place . Secondary osteoarthritis is possible.

literature

Thomas von Rothkirch, O. Schwarz, Rüdiger Döhler : Köhler's disease I - long-term observations in 31 cases. In: Contributions to orthopedics and traumatology. 34: 351-364 (1987).
Andreas B. Imhoff, Ralf D. Linke, René Baumgartner: Orthopedic checklist. 2nd, completely revised and expanded edition. Thieme, Stuttgart et al. 2011, ISBN 978-3-13-142282-8 .
E. von Stillfried, M.-A. Weber: Aseptic osteonecrosis in children and adolescents. In: The orthopedist. 43 (2014), 8, pp. 750-757.
Heidi L. Tuthill, Evan R. Finkelstein, Allen M. Sanchez, Paul D. Clifford, Ty K. Subhawong, Jean Jose: Imaging of Tarsal Navicular Disorders, A Pictorial Review. In: Foot & Ankle Specialist. 7 (2014), 3, pp. 211-226.

Individual evidence

↑ A. Köhler, EA Zimmer, J. Brossmann, C. Czerny, J. Freyschmidt: Limits of the normal and beginnings of the pathological in the radiology of the child and adult skeleton. Thieme, 2011, ISBN 978-3-13-362214-1 .

[1] A. Köhler, EA Zimmer, J. Brossmann, C. Czerny, J. Freyschmidt: Limits of the normal and beginnings of the pathological in the radiology of the child and adult skeleton. Thieme, 2011, ISBN 978-3-13-362214-1 .