Keller disease: causes, symptoms and treatment
About pathology, the features of which the German radiologist Keller told the world in the last century, very little information is known today. The disease, named after its discoverer, is an aseptic necrosis of the navicular bone or the heads of the metatarsus, due to which the disease falls into the category of osteochondropathy.
Pathological changes of the feet of this kind appear most often in childhood, although there are cases of medicine where adults have been exposed to anomalies. Keller disease is often diagnosed in boys aged 5-7 years and adolescent girls.
Keller's pathology is chronic osteochondropathy, which occurs as a result of degenerative changes in the spongy substance of the tubular bones and often causes the emergence of aseptic necrosis or microfractures in affected areas. Anomaly covers the navicular and metatarsal bones.
A defect is found in patients of completely different ages, but more often young organisms are exposed to it.
Keller's disease in children is much more aggressive than in adult patients and is characterized by pronounced symptoms, a malignant form and a multitude of symptoms that require immediate reaction and medical assistance.
According to doctors, pathology, regardless of its type, appears against the background of disorders of high blood flow in the tissues of the foot, because of which their supply with micronutrients and oxygen is deteriorating. The ICD-10 Keller disease code is M92.
The origin of this process is facilitated by various conditions, including:
- tissue injury;
- chronic and acute intoxication;
- hormonal disruptions;
- metabolic disorders;
- infection of the distal extremities;
- prolonged use of uncomfortable or too tight shoes;
- acquired and hereditary deformities of the foot;
- congenital abnormalities of blood flow.
The clinical picture of this defect manifests itself in the form of many typical symptoms.Usually, the development of the disease begins with edema of the soft tissues of the back of the foot, which indicates the progression of degenerative processes in the bones.
Tumors are not characterized by any signs, it is practically not accompanied by pain - they can occur only when running or walking.
A few days after the onset of edema, he passes away on his own, bringing the apparent effect of apparent recovery. In fact, such a miraculous disappearance of a tumor should not be ignored under any circumstances, since it indicates the transition of Keller's disease to the next stage.
Sometimes pathology can be completely asymptomatic. In patients who are not even aware of the presence of an abnormality in their bodies, the disease is often detected quite by accident, for example during a routine examination or X-ray. In the absence of timely treatment, Keller's disease can lead to more serious consequences, among which should be highlighted:
- the formation of various deformities of the foot or complex types of flatfoot;
- development of arthrosis;
- disorder in the work of small joints.
In 6% of all cases, the disease leads to disability.
Keller's disease of type 1 in children is characterized by swelling in the area of localization of the scaphoid and its projection on the back side of the foot. However, other signs of inflammation, such as a local increase in skin temperature or hyperemia, may be completely absent. And this suggests that pathology has a non-infectious nature.
Almost in parallel with the appearance of a tumor near the navicular bone, pain syndrome also occurs, the intensity of which increases at the time of physical exertion on the distal extremities. As a result of constantly increasing pain, the child gradually begins to limp and lean on the outer edge of the foot. Over time, the pain syndrome becomes permanent and bothers the patient even in a state of complete rest.
Keller's disease type 2 occurs most often in girls during puberty and manifests as swelling. Patients complain of pain in the metatarsal bones. As in the case of the first type of the disease, signs of the inflammatory process are absent.
At first, the pain appears during walking and is localized in the forefoot. As the defect develops, the pain syndrome in the metatarsal bones increases and becomes permanent. In adults, Keller type 2 disease usually lasts for about 2-3 years, after which it is transformed into aseptic necrosis of the affected area or its fragmentation into small fragments. The consequences of this pathology can significantly affect the quality of life of the affected person.
For the detection of Keller's disease, an orthopedist makes a thorough examination of the injured leg, as well as a detailed survey of the patient. The main method of diagnosis is radiography.
In the pictures with type 1 Keller's disease, the extent of damage to the scaphoid bone is consistently identified, as well as its flattening and compaction, the complete resorption of fragments, and then its regeneration to the original parameters.
In case of Keller's disease of type 2, the height of the metatarsal heads is reduced, as well as their compaction. In addition, there is a change in the articular closure plate, an increase in the cleft of the metatarsophalangeal joints and fragmentation of the bones — all this can also be seen on X-rays.Even after appropriate therapy, the complete regeneration of normal parameters of damaged heads almost never occurs.
General Keller Disease Treatment Principles
The effectiveness of therapy for this pathology is directly dependent on the timeliness of diagnosis and the correctness of the selection of the scheme. In the early stages of the formation of aseptic necrosis in children, conservative treatment is carried out, which involves the use of several techniques:
- elimination of excess load from the foot by complete immobilization of the injured limb - the imposition of a plaster cast for 1-2 months;
- unloading of the foot through the use of orthopedic insoles, instep supports, linings, thereby eliminating tension from the scaphoid and metatarsal bones;
- the use of analgesics to block pain;
- use of general and local anti-inflammatory drugs to eliminate edema and pain;
- the use of drugs based on phosphorus and calcium, which help to balance metabolism and stimulate the restoration of bone tissue;
- physiotherapy - herbal baths, heat therapy, electrophoresis;
- Exercise therapy is an integral part of the treatment of Keller's disease in adults and children during the recovery phase, implies the implementation of a specific set of exercises.
Both in the case of the first type of disease, and in the pathology of the second form, surgery is extremely rarely prescribed to patients, exclusively at advanced stages.
- Treatment of Keller's disease in both children and adults involves the use of medicines as part of a comprehensive regimen.
- Nonsteroidal anti-inflammatory drugs and non-narcotic analgesics. These medicines are recommended for patients to get rid of pain. Since the disease most often manifests itself in childhood, the use of drugs that contain ibuprofen or paracetamol is used as a painkiller. The rest of the medication is usually not used in pediatrics. In the treatment of adult patients, the use of other drugs from this category is acceptable.
- Preparations for the stabilization of calcium-phosphorus metabolism.
- Means to improve peripheral blood flow. Their use is necessary for the normalization of full blood circulation and stabilization of bone tissue supply. Taking into account the patient's age, the following may be prescribed: Actovegin, Trental, Kavinton, Zinnazarin, Bilobil, Stugeron, Pentoxifylline, Tanakan.
This method of treatment is aimed only at eliminating unpleasant symptoms: pain relief and elimination of edema.
Such therapy begins with the use of thermal baths, for the manufacture of which used simple sea salt. Feet should be dipped for half an hour in a hot solution, and then rinse and wipe dry. This procedure is recommended daily, preferably in the evenings. Treatment of Keller's disease with the help of folk recipes can be combined with traditional medicine. But this can be done only with the permission of the attending physician.
Of course, the disease of the 2nd type requires more serious therapy with the full immobilization of the distal parts of the injured limb.Traditional medicine in this case can only reduce the intensity of the pain syndrome. That is why in the event of the first warning signs of pathology, it is urgent to contact an orthopedist.
In case of anomaly of the 1st type, during the operation, two channels are made into the navicular bone, into which the vessels grow and provide the necessary nutrition for the tissues. Usually, after surgery, the pain syndrome quickly retreats and never returns. During the rehabilitation period, the patient is recommended to undergo a course of massage, physiotherapy and exercise therapy.
When a type 2 Keller's disease is detected, surgery is required much less frequently. Surgical intervention is necessary only when joining deforming osteoarthritis. In such situations, bone growths are eliminated, and a specific spherical shape is attached to the head of the tarsus. It is impossible to resect the entire bone, because of this, the limb may lose significant support.
As you know, any defect is always much easier to prevent than to treat.Prevention of Keller’s disease in children and adults suggests:
- correct selection of shoes;
- rejection of unbearable physical exertion;
- systematic examinations in medical institutions;
- timely treatment of various injuries;
- early diagnosis of problems associated with foot deformities.