Deutschlander's disease is damage to the bones of the metatarsus. The pathology is named after the doctor who described this disease in 1921. The disease occurs due to increased stress on the legs. It is characterized by changes in bone structure. Identifying such a disease can sometimes be quite difficult. Sometimes even experts mistakenly diagnose this disease as osteomyelitis or bone tumor. This pathology is otherwise called marching foot, as it often occurs in young soldiers after long forced marches.
Pathogenesis
The metatarsus is the middle part of the foot. It is located between the tarsal bone and the fingers. This section of the lower limb consists of five bones and experiences the greatest load when standing and walking.
With Deutschlander's disease, restructuring and partial resorption of bone tissue occurs. The second and third metatarsal bones are usually affected, as they bear the heaviest load. On an x-ray, the changes appear as if one part of the bone has partially separated from another. Therefore, the disease is often called a march fracture.
However, this pathology does not result from trauma. It does not completely tear off the bone. This disease is only superficially similar to an incomplete fracture. Over time, the affected areas are covered with normal bone tissue. Therefore, many experts consider the term march fracture obsolete.
X-ray changes in this pathology can be seen in the photo below.
Creutzfeldt-Jakob disease - symptoms and treatment
Early diagnosis of the disease is difficult. Generally, preliminary diagnosis is made clinically or based on data obtained from already identified familial cases. If Creutzfeldt-Jakob disease is suspected, genetic analysis may be performed .
In general making a diagnosis remains a difficult problem , since the disease does not have any specific changes in the picture of general and biochemical blood tests. Sometimes there is an increase in liver transaminases (enzymes that provide the most correct data for laboratory diagnosis of liver problems) and alkaline phosphatase (an enzyme for laboratory diagnosis of diseases of the bones, liver and heart), which is also not specific only to Creutzfeldt-Jakob disease. There are also no specific immunological markers.
The definitive diagnosis is made by biopsy or autopsy . Previously, only the study of brain tissue was considered reliable, but now options for studying a biopsy of the palatine tonsils are described. Biological methods are also used - healthy nervous tissue of laboratory animals is infected with the tissue of the patient being studied, with subsequent determination of the presence of infection in the animal [1][5].
In combination with clinical data and medical history, electroencephalography . Already in the early stages of the disease, the bioelectrical activity of the brain slows down. As the disease progresses, periodic two or three-phase sharp waves with a frequency of about 2 Hz appear. But these changes are not typical only for prion diseases and can occur in various brain diseases that arise from metabolic disorders. With some genetic variants of Creutzfeldt-Jakob disease, there are no changes in the electroencephalogram at all.
MRI the brain. These changes are also not decisive and are found in other pathologies of the nervous system [1][5].
The composition of the cerebrospinal fluid may remain normal for quite a long time during the disease. Afterwards, a specific protein is released, which manifests itself specifically in Creutzfeldt-Jakob disease, but it also occurs in cerebrovascular accidents and inflammatory diseases of the nervous system. However, if there are no other symptoms of inflammation, Creutzfeldt-Jakob disease can be assumed. At later stages, neuronal enolase is detected in the cerebrospinal fluid - an active substance involved in carbohydrate metabolism, which occurs during the breakdown of nerve cells. The presence of neuronal enolase is also not specific only to prion diseases; its increase is observed in tumors of the cerebral cortex and neoplasms of the thyroid gland.
Thus, despite the development of genetic and immunochemical diagnostics, intravital diagnosis of Creutzfeldt-Jakob disease remains a problem due to the variety of forms of development, clinical manifestations and course options.
Risk group
The disease most often develops in patients with flat feet. Also at risk are people whose activities involve increased stress on their legs:
- recruit soldiers;
- tourists;
- athletes;
- dancers;
- tour guides;
- waiters;
- hairdressers.
Wearing uncomfortable shoes can provoke Deutschlander's disease. Pathological changes in the metatarsal bones are often observed in women wearing high-heeled shoes.
This disease often develops in untrained people. In a person who is not accustomed to intense physical activity, pathology can occur even after systematic long walks.
Symptoms
The acute form of the disease develops 3-4 days after heavy load on the legs (for example, a long hike or forced march). The patient has pain in the foot and swelling above the metatarsal bones. The discomfort can be quite intense.
The primary chronic form of the disease is more common. Symptoms of bone damage increase gradually. At first, the pain is mild and does not interfere with movement. The patient often wonders why his foot hurts, because he has not had any injuries.
Over time, the pain becomes intense and unbearable. The patient begins to limp severely. A person tries to step on the injured limb as little as possible due to pain in the foot. The swelling on top of the metatarsus looks like a dense edema. There is pain when pressing on it.
Very rarely, slight redness of the skin is observed in the area of edema. At the same time, the patient’s general well-being is not impaired, there is no high temperature or weakness.
Such symptoms may bother the patient for 3-4 months. Then the pain subsides, and the pathology ends with recovery. The changed areas of the metatarsus are covered with normal bone tissue. We can say that this disease always ends on its own and does not cause complications. However, you should not neglect therapy. The pain associated with this pathology can be very severe. Often the patient cannot move normally due to discomfort.
How to determine the disease?
Diagnosis of Deutschlander syndrome is not particularly difficult. The easiest way to identify a marching foot is palpation. If pressing on the metatarsal bone leads to severe pain, and there is obvious swelling in the affected area, we are talking about this disease.
Fresh fractures may be detected by MRI. Using special techniques, the radiologist notices a decrease in tissue density, which means that there are cracks in the metatarsal bone. Such fractures do not require reduction.
Diagnostics
This pathology is treated by a traumatologist or orthopedist. The most reliable diagnostic method is an x-ray of the foot. The following changes can be seen in the image:
- At the onset of the disease, changes in the structure of bone tissue are visible. You may notice an oblique or transverse light stripe. It is in this area that pathological bone restructuring occurs. This looks a lot like a fracture. The bone seems to be divided into two parts. However, unlike a true fracture, there is no tissue displacement.
- Subsequently, growths appear around the site of the lesion, and then a bone callus forms. The light stripe gradually disappears.
- During the recovery stage, the callus resolves. However, the bone remains thickened.
Taking an anamnesis plays an important role in diagnosing the disease. It is necessary to establish that the patient has not had any previous injuries to the extremities.
X-ray signs of bone tissue damage may be absent in the first days and even weeks of illness. Therefore, it is recommended to repeat the examination several times.
Symptoms
The main signs of marching foot are minor pain and swelling in the affected area. An x-ray taken during the acute period of the disease reflects the characteristic locations of fractures. Damage to bones occurs according to the green stick principle - only deep bone tissues break, while the superficial ones remain unchanged. These signs can be seen in detail in the photo.
Photo. Closed fracture of the fifth metatarsal bone in the picture
Healing begins 1–2 months after the injury. A stress fracture is always closed.
Treatment methods
Unlike a real fracture, Deutschlander's disease does not require a cast. However, it is necessary to temporarily limit the load on the legs.
The patient is advised to remain in bed for 8-10 days. A splint is placed on the affected limb for a period of 1 month. This provides rest to the leg and promotes rapid healing of the injury.
For severe pain, analgesic ointments and gels are prescribed:
- "Troxevasin";
- "Gevkamen";
- "Efkamon";
- "Bom-benge";
- "Boromenthol".
The use of warming local agents is not recommended. In this case, they aggravate the discomfort.
After removing the splint bandage, the patient is prescribed a course of physiotherapy. Massage, warm foot baths, and paraffin applications on the metatarsal area are indicated. In the future, patients are advised to use shoe insoles and avoid excessive stress on the lower extremities.
Prevention
We can conclude that this disease is easily curable and does not cause complications. However, it significantly reduces the patient's quality of life. Therefore, it is necessary to take measures to prevent pathology.
If a person’s activity involves stress on the legs, then it is necessary to periodically undergo a course of therapeutic massage. At home, it is useful to do foot baths after a working day. For long walks, you should wear comfortable low-heeled shoes. Newly recruited soldiers should be examined regularly by an orthopedic surgeon. This will help avoid damage to the metatarsal bones.
Methods of therapy
Fixing devices are not used to eliminate marching foot. The recovery period does not take much time. You can treat Deutschlander syndrome at home:
- Doctors recommend limiting the load on the forefoot. After recovery, you will have to temporarily abandon the activity that triggered the onset of the disease.
- Orthopedists advise wearing comfortable shoes equipped with special insoles. It reduces pressure on damaged bones and the intensity of pain.
- Deutschlander syndrome is an indication for the use of pain-relieving creams and ointments, which are applied to clean skin of the feet 3-4 times a day.
Treatment of marching foot with ultrasound or heat is not allowed. These methods interfere with the process of bone healing. Massage, which can be performed at home, is useful during the recovery period.
The disease almost always ends in complete recovery; health-hazardous consequences occur extremely rarely. Six months after bone fusion, the patient can return to normal activities.