Aseptic necrosis of the head of the XNUMXnd metatarsal (Köhler II disease)

Proven content

Aseptic necrosis of the metatarsal head affects the 11nd or 18rd metatarsal bones. It is more common in girls between XNUMX and XNUMX years of age. Symptoms appear after prolonged stress or dancing. In periods of exacerbation, limping, swelling and thickening at the level of the affected metatarsal bone may occur.

Aseptic necrosis of the head of the XNUMXnd metatarsal bone – what is it?

Aseptic necrosis of the head of the XNUMXnd metatarsal bone is also known as Köhler II disease. It is a condition characterized by the death of bone tissue and cartilage without the influence of pathogenic microorganisms. Köhler II disease most often affects the epiphyses of bones in developing children and adolescents. This is due to the lack of collateral circulation during adolescence (growth).

In the course of the disease, there is swelling, thickening at the level of the affected metatarsal bone, painful pressure and limitation of the mobility of the joint as a result of its degenerative-deforming changes. The term of this disease was introduced into medicine in 1910 by Georg Axhausen, a German surgeon. Among the sterile bone necrosis, as many as 40 disease entities can be distinguished, with a similar course and picture of lesions. The most common sterile bone diseases are:

1. Kohler’s I disease – osteonecrosis of the navicular – a condition most common in children aged 4-5 (sometimes 2 – years old); most often it attacks boys. The reasons for its formation are not fully known. Symptoms: mobility problems; pressure pain in the area of ​​the navicular; pain when putting weight on the foot ‘
2. Perthes disease – necrosis of the head and neck of the femur caused by ischemia, the causes of which are not fully known; at first, pain in the groin or knee area appears, especially after physical activity, and disappears after its completion. Due to the limited mobility of the hip joint, the child starts to move with a stiff hip. The treatment includes, among other things, complete relief of the limb and performing exercises to maintain or increase the range of motion in the hip joint;
3. Haglund-Sever disease – calcaneus necrosis, most often affecting children in the puberty period and adults in the 5th and 6th decade of life. It was first described in 1928, and its causes have not been fully defined. It is believed that the factors increasing the risk of ailments include, for example, infections, overstrain due to physical activity, wearing poorly selected shoes and abnormal anatomy of the calcaneus. Haglund-Sever disease affects both heels in more than half of patients. In the treatment, muscle stretching (triceps calf and back muscles of the thigh) is used. In addition, it is recommended physiotherapy treatments in the form of iontophoresis, laser therapy and sonotherapy.
4. Osgood-Schlatter disease – tibia necrosis; although this ailment was described over 100 years ago, the specific causes of its occurrence are still unknown. Some researchers believe that the source of the disease is various types of injuries and infections of the patella, or the avulsive action of the ligament caused by the intense work of the quadriceps muscle of the thigh. Osgood-Schlatter disease usually occurs in children 8-15 years of age, more often in boys. It manifests itself with tenderness below the kneecap and pain that increases after exercise. Sometimes there is swelling in the area of ​​the tibial tuberosity.
5. Scheuermann’s disease – necrosis of the end plates of the vertebral bodies;
6. Freiberg-Köhler II disease – necrosis of the II head (less often the third metatarsal bone).

Aseptic necrosis of the head of the XNUMXnd metatarsal bone (Köhler II disease) – causes

The causes of this ailment are not fully known. However, there are certain factors that increase the risk of its occurrence, such as:

1. mild arthritis,
2. blockages causing blood circulation disorders,
3. abnormal clotting
4. the body’s response to a systemic disease,
5. hormonal disorders,
6. microurazy.

Symptoms of Köhler II disease

At the beginning, there are minor pains that disappear after a short rest, so the first symptoms are very often underestimated. Also, the results of additional tests do not give cause for concern. Patients suffer from swelling of the skin, its increased warmth and pain when touched. In addition, the outlines of the limbs are distorted. With the development of necrosis, changes are visible in the radiological examination (foci of calcification, fragmentation and bone reconstruction). Treatment of ailments depends on the age, degree of deformity and the location of the lesions.

Diagnosis and treatment of aseptic necrosis of the head of the XNUMXnd metatarsal bone

To confirm the diagnosis of Köhler II disease, it is necessary to conduct a medical interview with the patient and perform imaging tests. X-ray examination is most often ordered, thanks to which it is possible to closely examine the changes and assess their extent. In turn, the treatment of the disease is not too complicated and has a good prognosis.

Patients should first resign from too intense physical effort so as not to put additional strain on the affected limb. Special orthopedic insoles are used, which not only support the arch of the feet, but also reduce pain. In addition, strengthening exercises play an important role. In patients with acute necrosis, anti-inflammatory preparations are additionally implemented.

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