Perthes Disease (Legg-Calve-Perthes Disease) - nonsurgical treatment

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Perthes disease which is also called idiopathic avascular necrosis of the femoral head is a rare childhood condition that affects the hip.
It occurs when the blood supply to the rounded head of the femur (thighbone) is temporarily disrupted.
The ball part of the femur can eventually collapse when the bone is weakened, if the blood supply is interrupted long enough.
When the blood supply returns to the ball of the femur, the bone can improve its strength,
but the shape of the femur can be permanently distorted.
Most children with Perthes' disease eventually recover.
Perthes disease takes place in four phases:
Phase 1( Necrosis stage ).
Phase 2: Fragmentation stage.
Phase 3: (Reossification stage ).
Phase 4: (Remodeling stage ).
as well as the child's age at the onset of disease, which affects the potential for bone regrowth.
Perthes disease usually affects children between the ages of four and eight years,
For the majority of children with Perthes disease, only one hip is ever affected.
If both hips are affected at the same stage of disease, that suggests multiple epiphyseal dysplasia (MED).
The cause of Perthes' disease is unknown.
Symptoms.
Painless limp.
change in the way child walks and runs.
Some children don’t feel much or any pain at all,
but others may feel an intermittent pain in the hip or groin, or in other parts of the leg, such as the thigh or knee that gets worse during activity and improves with rest.
Pain occurs without an injury associated.
Stiffness or decreased motion in the hip joint .
shortening of the affected leg, leading to uneven leg length.
Trendelenburg sign.
When standing on the affected leg, an abnormal tilting of the pelvis is indicative of weakness in the abductor muscles of the hip.
This Trendelenburg sign is often seen in children with Perthes disease.
Initial X-rays might look normal because it can take one to two months after symptoms begin .
Early findings on plain radiographs.
widening of joint space.
Caffey’s sign or crescent sign:
Later findings.
Fragmentation of femoral ossification center,
Lateral subluxation and flattening of femoral head.
About 60% of children with Perthes' disease recover without any treatment. especially very young children (those 2 to 6 years old) .
It is important, however, for all children to be carefully followed up by their doctor during the course of the disease.
They usually have to attend clinic every 3-4 months for examination and X-rays.
the aim of treatment are: resolution of symptoms, restoration of range of motion and containment of hip to protect the shape of the femoral head.
Painful symptoms are caused by inflammation of the hip joint.
Avoiding high-impact activities, such as running and jumping, .
crutches or a walker to prevent your child from putting too much weight on the joint.
physical therapy exercises .
If range of motion becomes limited or if x-rays or other image scans indicate that a deformity is developing, a cast or brace may be used to keep the head of the femur in its normal position within the acetabulum.
During the application, your doctor will take a series of special x-ray images called arthrograms
to see the degree of deformity of the femoral head and to make sure he or she positions the head accurately.
In an arthrogram, a small amount of dye is injected into the hip joint.
In some cases, the adductor longus muscle in the groin is very tight and prevents the hip from rotating into the proper position.
Your doctor will perform a tenotomy to release this tightness before applying the Petrie casts.
During this quick procedure, the surgeon makes a tiny incision in the groin and severs a tendon in the hip called the adductor.
The tendon grows back within a few months, allowing your child to move his or her hip more normally.
After the cast is removed, usually after 4 to 6 weeks, physical therapy exercises are resumed to restore motion in the hips and knees.
Your doctor may recommend continued intermittent casting until the hip enters the final stage of the healing process.
Surgery is most often recommended when: your child is older than age 8 at the time of diagnosis.
More than 50% of the femoral head is damaged.
Nonsurgical treatment has not kept the hip in correct position for healing.

[@QuintVandijk-vq5ji]

its not good to sit still with both legs stuck like that, i have the perthes disease myself. Its mutch better for the recovery of the hip and leg to go to someone who can help with stretching and moving your perthes leg. I recoverd myself by doing home exercises and staying active where i can so i can build my leg up step by step. please dont put your child in a leg brace like this video. Go see someone who can help your child step by step by doing exercises and stretching. on the long term you will just be not able to move and be flexible if you use the leg brace. so please just look for good help and stay active, do your exercises and keep stretching!
hope this helps!