Legg-Calvé-Perthes disease, also called Perthes disease, is a rare disease most common in male children between 4 and 8 years old, characterized by decreased blood flow in the hip region during the child’s development, mainly at the place where the bones connect with the head of the leg bone, the femur.
Legg-Calvé-Perthes disease is self-limiting, as the bone heals on its own over time due to the reestablishment of local blood flow, but it can leave sequelae. In any case, it is important that the diagnosis is made early to avoid bone deformities and increased risk of hip arthritis in adulthood.
The most characteristic symptoms of Legg-Calvé-Perthes disease are:
- Difficulty walking;
- Constant hip pain, which can lead to physical disability
- There may be sharp, intense pain, but this is rare, making early diagnosis difficult.
- Difficulty moving the leg;
- Limited range of motion with the leg.
In most cases, these symptoms only affect one leg and one side of the hip, but there are some children in whom the disease can manifest on both sides and, therefore, symptoms can appear in both legs, being called bilateral.
how to diagnose
In addition to evaluating the child’s symptoms and history, the pediatrician may also place the child in various positions to try to understand when the pain is most intense and thus identify the cause of the hip pain.
The tests usually requested are radiography, ultrasound and scintigraphy. In addition, magnetic resonance imaging can be performed with the aim of performing the differential diagnosis for transient synovitis, bone tuberculosis, infectious or rheumatic arthritis, bone tumors, multiple epiphyseal dysplasia, hypothyroidism and Gaucher disease.
How is the treatment done?
The main goal of treatment is to keep the hip centered and with good mobility throughout the disease process to prevent hip deformity.
This disease is considered self-limiting, improving spontaneously. However, it is important for the orthopedist to indicate the decrease or withdrawal of the patient from activities that exercise the hip and carry out the follow-up. To move around, it is recommended that the person use crutches or a lanyard, which is an orthopedic device that holds the affected lower limb, keeping the knee flexed by means of a strap fixed to the waist and ankle.
Physiotherapy is indicated throughout the treatment of Legg-Calvé-Perthes disease, with sessions being performed to improve leg movement, relieve pain, prevent muscle atrophy and prevent movement limitation. In more severe cases, when there are major changes in the femur, surgery may be recommended.
Treatment may vary depending on the age of the child, the degree of damage to the femoral head, and the stage of the disease at the time of diagnosis. If major changes are observed in the hip and femoral head, it is very important to start a specific treatment to avoid complications in adult life.
Thus, the treatment for Legg-Calvé-Perthes disease can be divided as follows:
Children up to 4 years
Before the age of 4, the bones are in the growth and development phase, so that most of the time they evolve to normality without any type of treatment.
During these types of treatment, it is important to make regular consultations with the pediatrician and with the pediatric orthopedist to check if the bone is healing correctly or if there is any worsening, being necessary to reassess the form of treatment.
Some factors can influence the final result of the treatment, such as gender, age at which the diagnosis was made, extent of the disease, time of initiation of treatment, body weight and whether there is hip mobility.
more than 4 years
Generally, after 4 years the bones are already well developed and with their almost final shape. In these cases, the pediatrician usually recommends having surgery to realign the joint or remove excess bone that may exist in the femoral head, due to the scars left by fractures, for example.
In addition, in the most serious cases, in which there was deformity, it may be necessary to replace the hip joint with a prosthesis, in order to put an end to the problem and allow the child to develop correctly and have a good quality of life. .
Always consult a doctor.
Verified by RJ985 – Brazilian natural medicine CMIO.org