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Osteochondrosis is degeneration followed by re-ossification of one or more ossification centers in children. The bones in children grow from ossification centers these are areas that are richly supplied with blood vessels in order to keep the bone growing. Occasionally this area will die back and stop growing this results in pain for the child. After a short period the body will re-grow blood vessels into the area and the ossification centre will start growing again. We typically see osteochondrosis pain as cyclic that is the child will complain for a week or two then stop complaining for a week or two. This is the reason that many parents fail to have the child checked. There are several areas that this can effect we have listed a few of these below:
Legg-Calve-Perthes disease – This affects the proximal femoral epiphysis its peak age is 4 to 8 years it is self limiting ie it stops when the child stops growing.
Osgood-Schlatter disease - ischemic necrosis / osteochondritis of the tibial tuberosity (insertion of patellar tendon, site of traumatic injury). It occurs between the ages of 10 to 15, more commonly in boys. It is probably a form of overuse syndrome, due to repeated avulsion stress on the tibial tubercle. X-rays are usually normal, and the diagnosis is usually made clinically by localised tenderness over the tibial tubercle. Treatment consists of rest for a few days and use of custom made orthotics to reduce traction. There is usually no need to restrict activities, as long as the child can tolerate the pain. No long term disability is expected, although there have been reports of cases where the tibial tubercle stays prominent and even tender long after maturation.
Kohler disease – this affects the navicular bone (see anatomy) and occurs in children between 3 and 9 years of age. The child presents with a painful foot, and diagnosed on X-rays which show a collapse of the navicular bone. Treatment consists of using a custom made orthotic, which relieves the pain. Total restoration usually occurs over a period of 12 to 18 months.
Freiberg infraction- Osteochondrosis of the metatarsal head usually 2nd, less commonly in the 1st and 3rd and it is more common in girls. The patient presents with pain with walking and is tender over the metatarsal head involved. X-rays show collapse of the metatarsal head. Treatment includes use of metatarsal pad often incorporated into custom orthotics to relieve pressure on the area while walking. Eventually the metatarsal head reforms, and the pain resolves, although the head is usually a little flattened.
Sever disease - Occurs in the heels, at the insertion of the Achilles tendon, and may be bilateral. It occurs between the ages of 10 to 12 in boys, and younger in girls. The child complains of pain in the heel with running, and is tender over the heel at the insertion of the Achilles tendon, and treatment consists of using custom made orthotics to relieve the stress on the heel.
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Page last updated 14 October, 2007