Osteochondritis/ AVN

Question 1

What is this?

Answer 1

• Kohler’s disease
• avn of navicular
• unknown aetiology

Question 2

Describe the epidemiolgy of kohler’s disease?

Answer 2

• occurs in young children 4-7 years
• 4x more common in boys cf girls
• 80% cases in boys

Question 3

Describe the pathophysiology of Kohler’s disease?

Answer 3

• the blood supply o fhte central 1/3 rd of navicular is watershed zone
  
  • accounts for susceptibility to avn and stress fx

Question 4

What is the prognosis of Kohler’s disease?

Answer 4

• typically self- limiting condition
• intermittent symptoms for 1-3 yrs post dx
• typically associated wth activity

Question 5

What are the signs and symptoms of kohler’s disease?

Answer 5

Symptoms

• Midfoot pain with associated limp
• Pain in dorsalmedial foot
• may have swelling, warmth
• Point tenderness over navicular

Signs

• Antalgic limp

Question 6

What is seen on xray with kohler’s disease?

Answer 6

• sclerosis, flattening and fragmentation of navicular
• most reorganise after if not they deform but most remain asymptomatic

Question 7

What is the tx for kohler’s disease?

Answer 7

Non operative

• NSAIDS
• ​Short walking cast
  
  • if pain with activities
  • outcome- decrease duration of symptoms
  • xrays improve 6-48 mo post symptoms
  • no reports of longterm disability
• No indications for surgery

Question 8

What is this?

Answer 8

• Iselin’s disease
• traction apophysitis of the tuberosity of 5th MT
• Often seen in active boys/girls between 8-13 yrs
  
  • common in soccer players/dancers

Question 9

What are the signs and symptoms of Iselin’s disease?

Answer 9

• Pain on lateral foot that is worse with activity
• tenderness over 5th MT
• xrays are norrmal

Question 10

What is the tx of Iselin’s disease?

Answer 10

Non operative

• Rest, activity modification, icing

Question 11

What is Sever’s disease?

Answer 11

• Common cause of heel pain
• thought to be an overuse injury of calcaneal apophysis in the growing child

Question 12

What is the epidemiology of Sever’s disease?

Answer 12

• Commonly seen in immature atheletes in running and jumping sports
  
  • frequently seen just before or during peak growth

Question 13

What is the aetiology of Sever’s disease?

Answer 13

• Unknown
• Due to traction apophysitis and repititive microtrauma esperienced during gait
• similar to Osgood schlatter’s disease

Question 14

What is the prognosis of Sever’s disease

Answer 14

• Self limiting
• Resolves with maturation & closure of apophysis

Question 15

What are the signs and symptoms of Sever’s disease?

Answer 15

Symptoms

• Pain in area of calcaneal apophysis in immature atheletes
• Pain with increased activity/impact
• can display warmth

Signs

• Tight achilles tendon
• positive squeeze test- pain with medial-lateral compression over tuberosity of the calcaneus
• pain over calcaneal apophysis

Question 16

What is seen on xray of Sever’s disease?

Answer 16

• Sclerosis maybe present in pt with/wout calcaneal apophysitis
• fragmentation is more frequently seen in Sever’s disease

Question 17

What is the tx of Sever’s disease?

Answer 17

Non operative

• Symptomatic tx
  
  • activity modification
  • achilles tendon stretching
  • ice
  • heel cups/pads
  • NSAIDS
  • short cast immobilisation for persistent pain
  • reocurrance is common
• No role for operative tx