Perthes Disease

Perthes Disease

Article by John Miller

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 and usually between the ages of 4-10 years old. 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?

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, often in the initial stages changes cannot be seen on an X-ray 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 the age of 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, and 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 may occur in more severe cases. 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. Post-surgery, your physiotherapist can help to provide stretching and strengthening exercises to assist with recovery and a return to activity.

Perthes Disease Prognosis

Sometimes those who have had Perthes disease require a joint replacement later in life. Children who have had 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 or has had Perthes, the physiotherapy team at PhysioWorks can help your child get back into normal activities and sport, and simply be a child again.

Hip Pain Treatment

A thorough analysis of WHY you are suffering hip pain from a movement, posture, or a control aspect, is vital to solving your hip pain.Only an accurate diagnosis of the source of your hip pain can solve the pain, quickly improve your day to day function, prevent a future recurrence,  or improve your athletic performance.The first choice of short-term therapy has been symptomatic hip treatment. This approach could include local chemical modalities such as cortisone injections or painkillers. Ice or heat could also assist along with some gentle stretching or exercise.However, persisting hip problems will require additional investigations to assess your joint integrity or range of motion, muscle length, strength, endurance, power, contraction timing and dynamic stability control.You should consult a healthcare practitioner who has a particular interest in hip pain and injury management, to thoroughly assess your hip, groin, pelvis, lower limb and spine. Due to the kinetic chain, they all have an impact, especially at the high athletic performance end. A quality practitioner will specifically educate you regarding your condition and combine with exercise and manual therapy as per the Clinical Practice Guidelines. (Cibulka et al., 2017) Hip pain education should also include teaching you specific activity modification, individualised exercises, weight-loss advice (if required), and methods to unload any arthritic joints.Recent research evidence-backed approaches have modernised physiotherapy treatment approaches to effectively managing hip pain. Together with a thorough hip assessment, your hip treatment can progress quickly to restore you to a pain-free hip and perform your regular sport or daily activities in the shortest time possible.For specific rehabilitation advice regarding your hip pain, seek the professional advice of high quality and up-to-date physiotherapist experienced in the assessment, treatment, prevention and optimisation of hip pain and related conditions. After assessing you, they will individually prescribe therapeutic activities based on your specific needs for daily living, values, and functional activities or point you in the direction of the most suitable healthcare practitioner for you and your hip condition.

Hip Pain Treatment Options

Your hip physiotherapist may consider an extensive range of treatment options including manual joint therapy to improve your joint mobility, muscle stretches or supportive taping. Your physiotherapist is also likely to add strengthening and joint control exercises as they deem appropriate for your specific functional and sporting needs.Please click the links below for more information about some of the conventional hip treatments that your physiotherapist may recommend or utilise for your hip pain.