Osteochondritides of the Foot - Lucy Dennell 4/3/2002

Sever's disease

Only 3 papers in Embase since 1988 and 8 in Medline since 1966, searching under" Sever's"

See attatched printout of two abstracts. The majority of the papers were overviews of the subject like the first paper.   The remaining papers were miscellaneous “ such as relationship to TaeKwon Do and to equinus deformity.

Kohler's disease “ described by Kohler 1908

Aetiology- described by Waugh    (JBJS 1958;40-B:765-777)“ noted to occur more commonly in late ossifying naviculars ? due to normal pressure on an unprotected ossifying nucleus

Only place for surgical treatment when presenting late - arthrodesis

Author               Gary A Williams + Henry Cowell

Title                  Kohler's disease of the tarsal navicular

Reference        CORR (158):53-8,1981 Jul-Aug

Summary         23 pts w radiographic changes in the navicular, 20 true Kohlers; 16 M‚:4 F, 3 asymptomatic.   Onset 2-9 years ; 6 y 2months M : 4 y 6months F. Fifty percent had prior foot problems; toeing in or CCV.     Follow up average 91/2 years(2m-25 y). Findings; all asymptomatic w normal radiographic appearance of the navicular (8 minor faceting, no arthritis).   Acute management 11pts short leg cast/9 pts shoe correction, rest or NWB w crutches.   Cast group had 3.2 m of symptoms, non had 15.2 m of symptoms.Also found that cast for less than 8/52 prolonged symptoms by six weeks.

Critique             Case series, retrospective. Made the point that Kohler's is primarily a clinical diagnosis. A description of the natural history of Kohler's.

Freiberg 's disease

The term infraction means an incomplete fracture of bone without displacement of the fragments( Campbell 's)

Aetiology   1914 Freiberg “ trauma, 1987 Crenshaw -excess pressure over metatarsal head causing microfractures, 1990 Stanley refuted trauma from pts histories, and refuted excess pressure using dynamic pedobarographic measures he suggested relative length of 2 nd metatarsal +- local bs to mt head

Stanley D et al Journal of foot surgery Vol 29(5)444-7 1990

Frieberg's disease (continued)

Management    " Freiberg 's Disease A suggested pattern of management" Helal B and Gibb P.Foot Ankle Vol 8. 1987, p94-102

Surgery rarely indicated "no single procedure has produced uniformly good results"

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