Perthes Disease

Perthes Disease

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Article by John Miller

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Perthes Disease

What is Perthes Disease?

Legg-Calve-Perthes Disease, or Perthes Disease for short, is a rare condition that affects children. It affects boys more than girls, usually between the ages of 4-10. It affects the hip joint and involves the femoral head (the ball part at the top of the thigh bone). The blood supply to this area of the bone becomes interrupted. With insufficient blood flow, the bone begins to die (avascular necrosis). This bone death results in a flattening of the femoral head. In most cases, this only occurs on one side.

What Causes Perthes Disease?

The interruption of blood flow, as explained above, causes Perthes. The cause of this interruption remains unknown.

What are the Symptoms of Perthes Disease?

Symptoms of Perthes disease include:

  • Limping- may or may not be related to pain.
  • Hip joint stiffness
  • Pain in the hip, groin, thigh or knee
  • Decreased range of movement of the hip
  • Shortening of the affected leg
  • Atrophy (wasting) of the surrounding muscles

How is Perthes Disease Diagnosed?

Clinical examination findings include a visible limp with walking and decreased hip joint range of motion. An X-ray may show the flattening of the femoral head. Changes cannot be seen on an X-ray in the initial stages but may be demonstrated by successive x-rays. At times an MRI or bone scan may also be required.

Please consult your hip physiotherapist or doctor for diagnostic assistance regarding Perthes Disease.

Perthes Disease Treatment

For children under 6, treatment is usually conservative and doesn’t require surgery. Because they are young and their bones still have a lot of growing and developing, the femoral head has more time to repair. Conservative management is where your physiotherapist can assist. Your child will require rest from high-intensity activities, including running, to prevent further damage to the hip joint.

Physiotherapy treatment will involve:

  • Advice and education on the condition and providing recommendations on relevant rest to assist with decreasing pain
  • Stretching exercises for the hip
  • Progressive strengthening exercises for the hip and leg
  • Crutches to decrease weight-bearing if walking is particularly sore

At times conservative treatment may also involve traction, where the hip is gently pulled out from the socket to help relieve pain; or casting to maintain femoral head alignment.

Surgery aims to improve joint alignment and the contour of the femoral head. Surgical methods range from releasing tight muscles around the hip to joint realignment. Surgery may occur in more severe cases. Post-surgery, your physiotherapist can help provide stretching and strengthening exercises to assist with recovery and a return to activity.

Perthes Disease Prognosis

Sometimes those with Perthes disease require a joint replacement later in life. Children with Perthes are also more likely to develop early onset of hip arthritis.

Your physiotherapist can aid in the detection and diagnosis of Perthes disease. If your child has had Perthes, the physiotherapy team at PhysioWorks can help your child get back into normal activities and sports and be a child again.

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