GOOD NEWS: HIS FEET WILL NOT FALL OFF!!

Today we went to The Orthopaedic Center at Hillcrest and saw Dr. Holderness. He was amazing, sweet and informative. The office was super nice and the staff was highly knowledgable. Our appt was fast which was great since I had to meet Hubs at his three month diabetes appt an hour later. I was in and out in less than one hour.

Yes, Elijah has STUFF in both feet!

The STUFF is a bone that stopped forming!!

The doctor had a really good laugh at that one and wondered how an orthopedist could not know about Kohler's disease. Elijah has Bilateral Kohler's Disease basically Kohler's Disease in both feet. Not half as bad as it sounds with the word disease at the end!! I think it should be called Kohler's Syndrome!! Not as bad, right!! I am not going to lie when I first heard it ~ I WAS SCARED! Until he said, "It is no where near as bad as it sounds and they should just change the name! It is a self-limiting and self-healing disease." Basically, the navicular bones in both of his feet stopped forming and just looked like "stuff". The left foot is already healing on its own explaining why he has no pain in this foot but instead some mild tenderness. The right foot has not started the healing process yet. At this point, he said it is ok for him to resume all activities including football. Elijah was very relieved to hear this little tidbit. He said, "Basically if it hurts him then he needs to rest and take ibuprofen for any swelling."

First, he said he would send him to get longitudes and arch supports (?) for his shoes. He would have put him in a cast for a few weeks but since his pain is not constant he thinks the inserts would be the best option. THEN he changed his mind since Elijah's bones are growing inward he decided to send us to get prescription shoes! I think right now this is more of a setback for me rather than him. I don't want him to get made fun of and hope that these orthotics are fashionable. If not, maybe we'll opt for the inserts! I know, I know!! I'll do whatever he needs but I don't want him emotional scarred for life because he got made fun of for his "special" shoes and then he turns into freakin' Forrest Gump with Avani as his "Jenna"!! I deal with all of that Thursady of next week at the orthotics/prosthetics appt. He also said later on this could also affect his heels but we would deal with that when and if it occurred! For those of you who are more detailed oriented here is what I learned on the internet............

Kohler's Disease

Kohler's disease is a rare bone disorder of the foot in children that may be the result of stress-related compression at a critical time during the period of growth. Kohler's disease is a condition, where the navicular bone in the foot undergoes avascular necrosis. Avascular necrosis is a disease resulting from the temporary or permanent loss of the blood supply to the bones. Without blood, the bone tissue dies and causes the bone to collapse. For some unknown reason, typically in a child, the navicular bone in the foot loses its blood supply for a while. It is characterized by limping caused by pain and swelling in the foot. It most often occurs in children between the ages of three and seven, and it affects males five times more often than it does females. Typically, just one foot is affected. Children appear to grow out of the disorder, and the affected bones regain their size, density and structure within a year. For some, however, symptoms may last as long as two years.

Symptoms
Kohler disease is a rare bone disorder characterized by a painful swollen foot. The foot is especially tender along the length of the arch. Putting weight on the foot or walking is difficult, causing further discomfort and a limp. For reasons that are not understood, the flow of blood to one of the bones in the foot (navicular bone) is interrupted, resulting in progressive degeneration of that bone. In a relative short time, however, the bone heals itself.Usually, symptoms will be mild, and patients may not seek treatment until the pain and swelling have persisted for a while (you know like almost a year in this Mother of the Year's case!).

Causes
The exact cause of Kohler disease is unknown. It does not appear to be hereditary and, until recently, was not thought to be linked to an injury. Some orthopedic specialists now believe that Kohler disease may be linked to an injury in the area around a bone (navicular bone) in the foot and may be the result of delayed bone formation (ossification). Structural weakness might result from an increase in the ratio of cartilage to bone. Since the navicular bone is part of the mechanism by which the foot moves (articulation), it is subject to weight-bearing pressures and stresses from twisting and turning. Under normal circumstances, the navicular bone is served by a blood vessel from which smaller arteries supply blood to the regions of bone growth. At around the ages of four to six, the blood supply to these regions of bone growth increases as other blood vessels reach them. If ossification is delayed, and the child gains weight, the effect is to compress the blood vessels, thus causing tissue destruction (ischemia). The navicula is the last tarsal bone to ossify in children. This bone might be compressed between the already ossified talus and the cuneiforms when the child becomes heavier. Compression involves the vessels in central spongy bone leading to ischemia. Ischemia causes clinical symptoms. Thereafter, the perichondral ring of vessels sends the blood supply, allowing rapid revascularization and formation of new bone.

Affected Populations
Kohler disease is a rare bone disorder of the foot that affects males more often than females. The disorder strikes children between the ages of 1 and 10 years with a peak occurring at ages 3 to 7 years. The center of bone growth that is affected in Kohler disease develops in young girls about one year before it appears in young boys. Nevertheless, the disorder is five times more prevalent in boys than girls. It is thought that the incidence of the disorder in the population is about 2%.


Standard Therapies
DiagnosisKohler disease is diagnosed with an X-ray of the foot and the presence of weight-bearing pain in the middle of the foot. Treatment ranges from weight-bearing short-leg plaster casts at one extreme to "watchful waiting" at the other. Special supportive shoes may also be considered. Staying off the foot as much as possible helps in recovery. Symptoms can last for a few days or persist for up to two years. However, symptoms usually resolve within a year.