Perthes Disease

Well done! You’ve taken the first steps to understanding and relieving your Perthes Disease! Once you read this page answer the questions on the sheet given by your physiotherapist at Musculoskeletal Physiotherapy Australia and bring that to your next treatment session. Recovery from your Perthes Disease is crucial in order to achieve your goals and gain rapid and long-lasting results. Your physiotherapist at Musculoskeletal Physiotherapy Australia has requested that you read this page so that you understand your condition and know how to best manage in between physiotherapy consultations.   Avascular Necrosis of the femoral head

What is Perthes Disease?

Perthes Disease, or officially termed Legg-Calvé-Perthes disease is a common condition affecting children ages 2 to 14. The average age of occurrence is 6 years old. It has no known cause but some theories suggest it may have something to do with environmental or genetic factors. The disease manifests as bone death of the femoral head (ball) of the hip bone due to issues with the blood supply. Over time, this will cause the hip bone to degenerate and ultimately fracture or deform. The pain felt is usually during the acute phases of the disease, with primary location of pain in the groin, hip or into the knee. Other features, apart from pain are abnormalities with walking or posture, atrophy (loss of muscle) in the leg musculature. Children will usually present with a limp that is worse after activity. Common antalgic (to avoid pain) gait patterns include a Trendelenburg gait and a Duchenne gait. (Pictured Right). Other common names for Perthes Disease include ischemic necrosis of the hip, coxa plana, oteochondritis and avascular necrosis of the femoral head.
Trendelenberg Gait

Trendelenberg Gait

   
Duchenne Gait

Duchenne Gait

   

What causes Perthes Disease?

Unfortunately, there is no known cause. It is 5 times more common in boys than girls and reports have indicated that the incidence is higher in children in rural areas and of lower socioeconomic class. The presence of this disease will unfortunately lead to worse outcomes into adulthood, such as permanent deformity or commonly, early osteoarthritis in the hips. The prognosis (outcome) of the disease will largely depend on the severity as well as the age of onset, with children developing Perthes disease later in childhood generally having poorer outcomes. Most current theories point to a mechanical loading event that triggers the disease process, followed by subsequent loading that further compresses the blood vessels. Subsequently, it has been found that hyperactive children are more likely to suffer from Perthes disease. Irrespective of the cause of the disease, the disease process manifests similarly in all cases, with eventual bone death of the femoral head (ball of the hip)which leads to either a fracture due to the bone not being able to withstand mechanical loads, or bony deformations. Perthes Disease

How can you help me with my Perthes Disease?

A detailed history, taken by your Musculoskeletal Physiotherapy Australia Clinician, of the pain or injury can determine the underlying cause of your Perthes Disease, while a physical assessment of the knee, lower back and surrounding structures, can determine the best course of action in treating the condition. Usually, treatment will involve correcting any abnormal gait (walking) biomechanics, and strengthening muscles to reduce muscle imbalances and tightness. Depending on the severity of your condition, surgery may be indicated. Otherwise, a combination of conservative medical management strategies, such as medications along with physical therapy can be sufficient in managing the condition.  

What should I do to avoid aggravating my Perthes Disease?

  • AVOID activities that aggravate your pain, until you have seen a Musculoskeletal Physiotherapy Australia Clinician.
  • REMAIN ACTIVE, while avoiding aggravating activities. Continue doing pain-free activities.
  • For RELIEF, applying ice to the area may help to reduce some pain and inflammation. Be sure to wrap the icepack in a towel, and only apply for 10 minutes every 2 hours. CEASE use if you have any negative reaction.
  • RECEIVE physiotherapy care to get your joints, ligaments and muscles de-loaded and moving freely with no restrictions.
Keep good care of your body and your physiotherapist will continue to monitor your condition.

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