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Keller's illness — the disease affecting foot bones. As a rule, it is diagnosed at youthful and children's age. Development of this illness is expressed by an osteochondropathy – gradual process of destruction of tissue of bone and the subsequent its recovery. For the first time this disease was described by the radiologist Keller from Germany, it happened at the beginning of the last century.
If at the person Keller's illness develops, in an organism there is a disturbance of inflow of blood to foot bones. As a result the necessary amount of oxygen and a number of the nutrients necessary for normal functioning of fabrics does not come to feet. Process of dying off of a bone tissue which in medicine it is accepted to call an aseptic necrosis begins. Foot fabric dying off at Keller's illness happens without participation of infectious processes. Among all variety of illnesses of bone system of the person of an osteochondropathy make about 3%.
The disease is shown as a result of a variety of reasons which lead to deterioration in the address of blood in the field of foot. First of all, it is various injuries of foot, continuous carrying close and inconvenient footwear of the wrong size. Keller's illness can develop at the people having arthritis, arthrosis, and also some diseases connected with endocrine and hormonal disturbances. One more important factor in this case is the hereditary favor to development of this illness. The acquired or inborn defects of foot (most often this flat-footedness) can lead to display of this illness also. An important factor also is disturbance of exchange processes in a human body. However specialists note that finally the exact reasons of osteochondropathies are not known still.
Physicians who diagnose Keller's illness, define two types of a disease, depending on that what damage of bones happens.
If at the person Keller's 1 illness is defined, then it is about defeat of a navicular of foot. This bone is located at an inner edge of foot. Keller's illness 2 is shown by pathological changes in heads of the second and third plusnevy bones of foot. These bones connect joint surfaces to phalanxes of fingers. Keller's illness 2 degrees develops at teenagers more often.
Besides, defining symptoms which show an osteochondropathy, doctors divide the course of a disease into several stages. At a necrosis stage the patient has a death of the bone beams which are structural elements of bones. Such changes are brightly expressed, they can be made out even on a photo. At a stage of a compression change there is a formation of new elements of a bone tissue, however now they have no sufficient durability yet. During this period bone beams cannot often sustain strong loading. Thereof there are their changes, and beams can put each other. Further the stage of fragmentation at which osteoclasts (those cells which destroy a bone), promote a rassasyvaniye of bone beams follows. The closing stage of a disease is a process of recovery of a form, and also structure of a bone. The answer to a question how to treat an illness, directly depends on what stage of an illness takes place at the moment. Therefore treatment of an illness of Keller can be begun only after careful professional diagnosis.
Keller I's illness is in most cases diagnosed for boys preschool children aged from 3 till 7 flyings. Initially the child notes morbidity and signs of a swelling on the back of an inner edge of foot. Because of morbidity limping at the child who tries to lean in the course of walking on opposite, outside part of foot is noted constantly. As a rule, the disease affects only one foot. It proceeds about a year then pain gradually stops.
Keller II's illness is most often diagnosed for teenage girls. It was described for the first time by the traumatologist Freyberg from the USA, and Keller studied this type of a disease in more detail and gave its description. This form of an illness often happens bilateral. As a rule, the beginning of an illness remains unnoticed. Initially in the field of a head II or III plusnevy bones develop pain. They are shown at once when load of front department of foot is given, and after the patient feels pain and at rest. Emergence of lameness is gradually noted, the patient cannot go to footwear with a thin sole, it is very difficult to it to go barefoot, especially if a surface uneven. Where pathological process — on a foot dorsum develops — hypostasis is shown. That finger which is located near a head of the affected bone becomes shorter, the movements in a joint are limited. All these symptoms are present at the patient for about two years then pain gradually begins to abate. However if for this period there were changes in a joint, then pains soon can be shown again. Family cases of defeat of feet are sometimes diagnosed. Most often the illness is localized at a head II or III plusnevy bones, but damage of several bones happens seldom.
Keller's illness is diagnosed on the basis of the found changes in bones which were struck. X-ray films allow to define them. The type of an illness is defined depending on where processes of destruction or recovery of tissue of bone specifically develop. Very often Keller I's illness is defined accidentally when X-ray inspection is conducted in other occasion.
At Keller I's illness an osteochondropathy the navicular is surprised. In development of this type of a disease there is a navicular change. Treatment of a disease, as a rule, happens after accidental establishment of the diagnosis when the doctor reveals the closed foot bone fracture. On x-ray films at this type of an illness it is accurately visible how the foot navicular collapses. It is necessary to consider that if the hand navicular is surprised, then the speech already goes about Ireyser's illness, but not about Keller's illness.
As a rule, Keller's illness 1 is treated by means of conservative therapy. If in the course of diagnosis the brush navicular change was revealed, then treatment is carried out with use of a plaster bandage. At defeat of foot of a leg it is necessary to provide its unloading and the subsequent immobilization. Foot which hurts needs to be held in a condition of an immovability. In most cases gypsum on foot or a brush (at damage of a wrist) is imposed for four weeks. After removal of gypsum of the child which had an aseptic necrosis earlier it is necessary to limit in mobility. Sometimes to the patient is shown to go with a cane or to move by means of crutches. After gypsum removal it is desirable for child to carry special insoles which are made by the individual order. If insoles are made correctly, their use gives the chance to reduce that pressure which is the share of a navicular. Therefore, the child does not suffer from severe pain, and food of fabrics is recovered quicker. Very important point in the course of treatment – carrying by the child correctly picked up orthopedic footwear which allows to keep the correct form of foot.
It is not necessary to jump, run during recovery that in a bone of foot the crack was not formed. Besides if bones after a change grow together not at once, then the nearthrosis can be formed later. At such state the structure, and also a form of the resisting bone fragments changes. Sometimes in this case the surgery therefore by the rehabilitation period at Keller's illness it is necessary to treat with special attention is required.
That the bone was recovered quicker, to the patient medicines which promote blood circulation improvement, and also a metabolism in an organism are appointed. To the patient administration of drugs, activating an exchange of calcium and phosphorus in an organism is appointed. Vitamins B, E, and also complex vitamin drugs which contain calcium in a bioavailable form can be appointed. Sometimes the doctor appoints an electrophoresis course with calcium chloride, analgetics, niacin. Besides, the good effect is noted during the carrying out thermal procedures, use of hardware physiotherapeutic methods.
Operational treatment practices rather seldom. However when severe pains are noted, and the effect of conservative therapy is not observed, carrying out the revascularizing osteoperforation is possible. At such operation in a navicular small channels in which new vessels rather quickly burgeon are made. It allows to improve significantly food of a bone which is recovered more actively. As a result, Keller I's illness recovers much quicker.
On condition of the correct approach to treatment and at timely use of all specified methods the child recovers, and disturbances of functions of foot after an illness are not noted. But if an illness not to treat that happens very often in view of lack of diagnosis, the form of a navicular is often broken, and at the child flat-footedness develops.
Treatment of an illness of Keller 2 consists, first of all, in restriction of movements. It is reached by means of imposing of a bandage from gypsum on foot. Such bandage should be carried for 3-4 weeks, and after its removal it is necessary to avoid too strong loadings. Besides, physiotherapeutic procedures, sessions of massage of muscles of foot and a shin are appointed. Also special remedial gymnastics is effective in this case. Also carrying orthopedic footwear, periodic bathtubs for legs practices. It is important to consider that in the absence of treatment the illness can proceed about three years, and, besides, function of a joint can be broken.
Deformations of a musculoskeletal system, an osteoarthrosis, flat-footedness, a joint contracture can become complications of an illness of Keller in the absence of adequate treatment.
To provide the correct approach to questions of prevention and to warn a course of a disease of Keller of both forms, parents need to take care of that children always wore only the convenient and suitable by the size shoes, first of all. It is also important to reduce mechanical load of feet of legs. To provide performance of this condition, it is not necessary to allow serious exercise stresses at children preschool children. When receiving any injury of foot it is necessary to address surely the doctor and to pass the researches appointed by it. It is also important to pay attention to existence of deformation of foot and it is obligatory to consult about it with the specialist.
Section: Orthopedics and traumatology