Foot

Kohler's Disease

DefinitionKohler's Disease

 

Osteonecrosis of the navicular

 

Epidemiology

 

Present at age 4-6 years

- same as Perthes disease

 

M:F 5:1

 

Bilateral in 20%

 

Aetiology

 

Repetitive trauma to maturing ossific nucleus

Anatomical Approach to Biopsy

Region specific approaches

 

Theory

- want to traverse one muscle / one compartment

- keep away from NV bundle

- as a rule perform open biopsy through compartment the tumour is in

- this is the compartment that will require surgical removal in wide excision

- direct approach without going through muscle if possible i.e. tibia, distal ulna

 

Lower Limb

 

Thigh

 

Knee & Foot

Principles

 

Foot

 

A little equinus is better than calcaneus

A little valgus is better than varus

A little varus is better than severe valgus

TA lengthening is most over used operation in CP

 

Knee

 

A little knee flexion is better than recurvatum

 

Knees

 

Problems

 

Tight hamstrings 

Foot & Ankle Exam

Look

 

Aids

Shoes - raises / wear patterns

Stigmata generalised disease

Hands - RA, CMT

 

Front

 

Knee alignment

Forefoot - Hallux & Lesser toes 

Scars

Circulatory changes

 

Medial Side

 

Turn affected side away & ask to step foot forward

Flexed attitude of knee

Medial arch - planus / cavus