Keller's disease is a form of osteochondropathy in which degenerative changes in the structure of the trabecular bone of the foot occur. The disease most often occurs in children and adolescents, however, adults can also suffer from this pathology. Below we consider the factors leading to the development of pathology, its signs and methods of diagnosis and treatment.
The mechanism of the development of the disease
Foot osteochondropathy was first described in detail by a radiologist from Germany Keller in 1908. At the moment, pathology is pretty well studied by doctors. As a rule, Keller’s disease is characterized by a chronic course. Specialists distinguish two forms of pathology depending on the area where it is localized and the size of the lesion.
The disease of the first type is localized in the scaphoid, which is located in the central part of the foot. Pathology can develop in both one and both feet at once. This form of Keller's disease in children is most often diagnosed at the age of up to seven years (and, in boys).
The pathology of the second type is localized in the head of the second and third bones of the metatarsus, which are articulated with the toes at the base. This form is typical for girls in the age group of 10 to 15 years.
Complications
The most common complications of the pathology are:
- Necrosis or death of bone tissue of the foot.
- Micro fractures.
Both forms of the disease have the same development mechanisms. The main cause of the appearance of pathology is considered insufficient or absent local blood supply. That is, for certain reasons, for one reason or another, blood in sufficient quantities stops flowing. Such a deficiency of oxygen and nutrients leads to the gradual destruction of bone structures, provoking the appearance of necrosis of non-microbial origin.
Causes
There are a number of factors that can trigger the development of Keller's disease. So, to the violation of the blood circulation of the foot can lead to:
- Heredity, that is, a predisposition to pathology at the genetic level.
- Frequent injury to the feet.
- Long wearing tight shoes.
- Foot defects.
- Endocrine diseases.
- Metabolic disease.
- Pathological processes in the vascular system.
Stages of the disease
In addition, Keller's disease goes through several stages of its development, namely:
- Aseptic bone tissue death.
- Compression fractures.
- Fragmentation.
- Reparations.
With the above reasons, aseptic necrosis can lead to the death of structural elements of the bones of the foot, as well as to a decrease in the density of the bone tissue itself. Thus, the bones of the foot lose their basic functions and become unable to withstand the loads that are imposed on them by the weight of a person.
What happens in the next steps?
With the further development of pathology, frequent microfractures occur, which is due to the loss of bone strength. In the fragmentation period, decay of bone elements that have been broken or undergone necrosis is observed.
With timely measures taken and timely restored blood supply to the bones, the repair phase begins, that is, the gradual tissue regeneration.
Symptoms of pathology
Manifestations of Keller's disease in children and adults differ depending on the form of pathology. However, there are common characteristics for all varieties:
- Severe soreness of the foot when walking.
- Swelling of the foot.
- Limited lower limb functionality.
In the advanced stage, Keller's disease increases the intensity of the symptoms, the gait of a person can change, lameness develops. A characteristic feature of the pathology is the absence of an inflammatory process in the affected area of the foot.
In children for Keller’s disease (we can’t provide a photo for aesthetic reasons), the first type is characterized by edema in the central part of the foot, namely, in the scaphoid. Palpation of the affected area of the foot leads to pain and discomfort. Unpleasant sensations become more intense in the process of movement, it is common for a person to tire quickly. With any, even slight movement, the patient is forced to rely on the outer part of the leg, which leads to noticeable lameness over time. Most often, the pathology is localized in one foot.
The non-infectious nature of the disease is indicated by the absence of such manifestations as an increase in body temperature, redness of the skin in the affected area.
On average, the pathological process develops over a period of one year and ends with a complete recovery and chronic deformation of the scaphoid.
For Keller’s disease of the second type, pathological processes in the head of the metatarsal bones on both feet are characteristic. Moreover, at the initial stage, the pathology proceeds in a latent form.
Over time, pain during physical activity in the front of the foot appears. The pain is not expressed, is not intense and goes away at rest. A visual inspection of the feet will show some shortening of the fingers and limited movement. In this form, the disease can last much longer, up to three years.
In childhood, the manifestations of the disease are more pronounced than in adults with Keller's disease.
Diagnosis of the disease
The basis for the diagnosis of pathology is an X-ray examination of the affected limbs. It must be carried out at all stages of the development of pathology. The x-ray will show osteoporosis of the scaphoid bone or metatarsal heads, which arose as a result of the destruction of their spongy structure.
Sequential x-rays of the foot, which was affected by Keller's disease (photo presented in the article) of the first type, there is a densification of the navicular bone, flattening and resorption of some of its parts. It should be remembered that proper treatment can return the bones to their previous state.
In a disease of the second type, an x-ray shows pathological changes occurring in the metatarsophalangeal joints, compaction and compression of the heads of the metatarsal bones and their fragmentation. With this development of pathology, a complete restoration of the affected bone tissue is not possible.
The neglected form of the disease is distinguished by the progression of the process of tissue death, debris defragmentation of the scaphoid, metatarsal heads, and also microfractures of the affected areas of the foot are visible in the pictures.
A very important stage of diagnostic measures is the collection of a detailed patient history. This will help determine the characteristic symptoms of the disease and identify a genetic predisposition to Keller's disease. How to treat a disease? More on this later.
Treatment of ailment
There are a number of conservative treatments, including:
- immobilization of the affected foot;
- strict restriction of the load on the foot;
- taking various drugs;
- physiotherapy;
- massage;
- physiotherapeutic procedures.
Immobilization of the affected foot is carried out in a certain way. The sore spot for several months should be in a plaster cast, which will simulate the shape of the foot in order to avoid deformation. It is necessary to completely protect the leg from any physical exertion. Such a measure will prevent the further development of bone necrosis and stop their deformation. During the treatment period, the patient should be moved with crutches.
After the gypsum is removed, the patient foot needs a sparing load regime . This can be achieved using special orthopedic shoes, insoles, pads, etc. For a long time it is necessary to exclude sharp and active movements, long walking and running.
Symptoms of Keller's foot disease, such as swelling and soreness, are eliminated by various medications. You can reduce pain or completely eliminate it by taking non-narcotic painkillers and NSAIDs such as Paracetamol and Ibuprofen.
In addition, doctors prescribe various vitamin complexes to patients, which contribute to the activation of phosphorus and calcium metabolism. Such drugs may be Aquadetrim, containing calcium complexes and multivitamins.
What else is important in the treatment of Keller's disease?
Normalize blood circulation in the affected area, as well as nutrition of bone tissue will allow drugs such as Tanakan, Actovegin, etc. In addition, there are a number of homeopathic medicines with proven effectiveness, for example, Osteochel S, Traumeel C, etc.
Physiotherapy with this pathology
The restoration of bone structures can also contribute to:
- massage;
- Exercise therapy;
- physiotherapeutic procedures.
All of these methods will allow you to develop a foot after recovery and restore mobility to it. Physiotherapy after plaster removal will help to reduce the recovery period. It will also prevent the deformation process. As a rule, with Keller's disease, electrophoresis, reflexology, iontophoresis, foot baths, etc. are prescribed.
It should be remembered that treatment with traditional medicine requires coordination with the attending physician in order to avoid deterioration.
Is there an operation for Keller's disease?
Surgical treatments for the disease
If conservative therapeutic methods fail, surgical intervention is prescribed. There are two main methods of surgical treatment:
- Revascularizing osteoperforation.
- Resection arthroplasty.
Revascularizing osteoperforation is a surgical procedure during which two holes are made in the bone undergoing deformation. Subsequently, blood vessels of the circulatory system germinate in these holes, providing blood to the affected areas of the foot. Thus, it is possible to relieve soreness, normalize metabolic processes and restore damaged tissue.
Endoprosthetics or resection arthroplasty is a serious surgical intervention, during which the damaged leg joint is completely replaced or undergoes reconstruction. In this case, natural materials are used - skin, bones and fascia of a person. The main indications for this surgical procedure are:
- Severe soreness of the foot.
- A significant limitation in the mobility of the affected joint.
During resection arthroplasty, excision and removal of the area of the joint that has undergone deformation, as well as modeling of a new one with restoration of its functionality, is performed.
Prevention of this pathology
Any pathology is much easier to prevent than to treat. Preventive measures to prevent the development of Keller's disease are as follows:
- selection of anatomically comfortable shoes, ideally orthopedic;
- avoidance of excessively intense physical exertion, especially in childhood;
- regular visits to the orthopedist;
- early diagnosis;
- timely access to a doctor when injuring the foot.
Conclusion and main findings
Thus, Keller's disease is localized in the foot and leads to the development of necrotic processes in this area. Most often, the disease is diagnosed in children. The main factor for the development of pathology is the wearing of uncomfortable, tight shoes, as well as increased physical activity on the foot. In addition, a genetic predisposition is also not excluded.
You should contact an orthopedist in a timely manner if discomfort or pain in the foot area is detected. This will help to avoid a radical treatment of Keller's disease in adults and children, and conservative therapeutic methods can be dispensed with.