Osteochondrosis, sometimes called osteochondritis, is a condition of
defective bone formation in the epiphysis or growing part of the skeleton.
No one knows the exact cause, although it is probably due to circulation
disturbance to that part of the bone.
Osteochondrosis can occur in many areas of the body, but the more common
examples are as follows.
- Freibergís disease occurs in the head of
the metatarsals of the foot, usually the 2nd or 3rd
metatarsal, usually between the ages of 12 to 15, and more commonly
in a girl. 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 to relieve pressure on
the area while walking. Sometimes, a piece of the involved bone gets
loose, and becomes a loose body in the joint, necessitating surgical
excision. Eventually the metatarsal head reforms, and the pain resolves,
although the head is usually a little flattened.
- Kienbockís disease occurs in the lunate of
the hand. It usually occurs in patients age 20 to 30 years of age, more
commonly in males.
- Kohlerís disease occurs in the navicular bone
of the foot, 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 an arch
support, which relieves the pain. Total restoration usually occurs over
a period of 12 to 18 months.
- Legg-Calve-Perthes' disease occurs in the
hip between the ages of 6 to 9 years of age, more commonly in boys.
Although the less severe forms recover with no problems, the more severe
forms in older boys can lead on to serious disability.
- Osgood-Schlatter disease occurs in the
tibial tubercle apophysis at the insertion of the patellar tendon. 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 localized tenderness over the tibial tubercle. Treatment
consists of rest for a few days and use of non-steroidal anti-inflammatory
medication. An Osgood-Shlatter brace to protect the patellar tendon
and tibial tubercle may be used for sports. 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
- Osteochondritis dissecans of the knee occurs
usually on the lateral part of the medial femoral condyle, usually in
the early teenage years. The etiology is probably due to repeated trauma
and vascular impairment to the area of the bone. The patient presents
with pain in the knee, and diagnosed on X-rays. Treatment consists of
casting and rest. If the involved bone starts to separate out, surgical
pinning may be needed.
- Osteochondritis dissecans of the elbow
occurs in the capitellum as well as the medial condyle and epicondyle.
Unlike Pannerís disease, it may form loose bodies and cause long-term
disability. It occurs in an older age group than in Pannerís disease,
occurring usually in the early teens. Treatment consists of strictly
enforced rest for the elbow to prevent long-term problems.
- Pannerís disease occurs in the capitellum of
the distal humerus at the elbow, and usually between the ages of 5 and
10, more commonly in boys. The patient presents with pain and inability
to extend the elbow fully after a trivial injury. X-rays are diagnostic,
and treatment consists of using a sling and restriction from strenuous
activity involving the elbow. The bone reconstitutes after a year or
two, and the patient usually resumes full function.
- Severís disease occurs in the heels, at the
insertion of the Achilles tendons, 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. X-rays are not diagnostic, and treatment
consists of using heel lifts to relieve the stress on the heel. Spontaneous
resolution is the usual course.
- Sinding-Larsen-Johannson disease occurs at
the inferior pole of the patella, at the proximal insertion of the patellar
tendon. It occurs in the same age group as in Osgood-Sclatter disease,
between 10 to 15 years of age. Etiology is probably similar, and so
is the outcome. No long-term disability is expected, and treatment is