Legg–Calvé–Perthes Disease is a childhood condition which occurs when too little blood reaches the femoral head of the hip joint for a short time. Without enough blood, this bone becomes weak and collapses and the bone cells die, a process called avascular necrosis.
A- Causes of Perthes Disease
- Repeated trauma or stress to the hip
- Genetic factors
- Delayed bone growth
- Blood clotting abnormalities
B- Risk Factors
- Boys are affected more commonly than girls
- Age between 4–10 years
- Low birth weight
- Nutritional deficiency
- Hyperactivity or excessive physical stress
C- Symptoms of Perthes Disease
- Limping while walking
- Hip pain
- Pain in groin, thigh, or knee
- Stiffness in hip joint
- Reduced hip movement
- Difficulty running or climbing stairs
- Muscle wasting around thigh
- Pain increases with activity
- Leg length difference
- Persistent limp
- Reduced weight bearing
D- Diagnosis
- X-ray
- MRI
E- Physiotherapy Management of Perthes Disease
Goals of Physiotherapy
- Reduce pain and inflammation in the hip joint
- Maintain hip range of motion
- Prevent deformity
- Improve muscle strength
- Improve gait, mobility and balance
F- Physiotherapy Protocol
1. Pain Management
- Hot fomentation
- Gentle stretching
- Activity modification
- Rest during painful episodes
2. Range of Motion Exercises
- Hip abduction
- Hip internal rotation
- Hip flexion-extension
3. Stretching Exercises
- Hamstring stretching
- Hip flexor stretching
- Adductor stretching
4. Strengthening Exercises
- Gluteal strengthening
- Core strengthening
- Quadriceps strengthening
5. Gait Training
- Correct walking pattern
- Weight-bearing training as advised
- Use of assistive devices if needed
6. Hydrotherapy
Exercises in water help reduce joint stress and improve mobility.
7. Postural and Functional Training
- Balance training
- Functional mobility exercises
- Sit-to-stand practice
G- Home-Based Protocol for Perthes Disease
- Gentle hip ROM exercises (10–15 minutes)
- Stretching exercises like knee to chest, frog leg stretch, leg split stretch
- Non-weight-bearing activities
- Rest breaks between activities
- Strengthening exercises like bridging, SLR, aeroplanes and superman
- Balance activities
- Relaxation and gentle stretching
Activities Suggested
- Swimming
- Cycling (light resistance)
- Gentle play activities
- Water exercises
Activities to Avoid
- Running
- Jumping
- High-impact sports
- Excessive stair climbing
- Heavy weight-bearing activities
H- Home-Based Care
- Maintain healthy body weight
- Use supportive footwear
- Encourage proper sitting posture
- Avoid prolonged standing
– Dr Soumya S Samal
