Module 27, General Medical Level

This is a 3 year old girl who presented to the emergency room with a complaint of left foot pain exacerbated by bearing weight. The previous day the patient's 4 year old sister had jumped onto her left foot during play resulting in immediate pain and an antalgic gait. She had no pain in the left foot prior to this episode. She was evaluated and radiographs were obtained. The radiology report said this was consistent with Kohler's disease and no fractures were noted.

Question 27A

Kohler's disease occurs in children of this age often following incidental trauma.

Question 27B

On physical examination the swelling was present in the forefoot which is consistent with Kohler's disease.

Question 27C

Laboratory tests which should be obtained are CBC and ESR.

Question 27D

The changes in the navicular may also represent an acute fracture from the play incident.

Question 27E

Immobilization in a walking cast would be the appropriate current treatment.

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