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PERTHES DISEASEWhat are the signs?Perthes disease is a serious condition in the growing child characterised by
This is not "growing pains", which in my opinion doesn't exist, in any case. Please, please, please! Do not neglect your child with a limp. This is a very serious condition which, if not caught and managed in its early stages, leads to multiple hip replacements and a ruined life. Early detection is essential for the treatment to be successful. Who gets it?In one sense the 'growing pains' diagnosis is correct. This condition occurs in the growing child, usually around 5 years old, but it can occur earlier and much later. I have seen boys around 12 developing Perthes.It is more common in boys, but the prognosis is worse for girls. Neglected, the first hip replacement may occur before your child turns 30 years old, and a wheelchair in the fifties is definitely on the cards. (I have two patients in exactly this scenario. A ruined life, I can assure you. And needlessly so.) A prophet of doom? Not so, because carefully and correctly managed, this is a very treatable condition. But it must be detected early. What is it?All tissue requires a nerve and blood supply. In Perthes Disease, a loss of the blood supply to the growing ball of the femur (the hip) occurs. No one is quite sure why this happens. It could be due to trauma, a fall for example; we're just not sure.Without its blood supply the growing 'epiphysis' dies, with fragmentation and resorption of the bone.
On the right you can see the normal epiphysis, sitting like the head of a mushroom on the top end of the femur, in the hip socket, but just look at the one of the left (L). See the fragmentation, the increased space in the hip, and the resorption of bone? This should have been caught much sooner. Problems, Mrs Corbishley, problems! TreatmentThe diagnosis of Perthes Disease is made from an X-ray, but in the early stages of the disease, the radiographs may be normal. If the age and symptoms fit, I assume Perthes until proven otherwise. It's such a serious problem, that it's better to assume Perthes, and be wrong, than vice versa.The most important part of the treatment is getting the weight off the leg. Crutches. Rigidly enforced. You don't mess with Perthes. Then gentle exercises of the hip are important. Movement of the joint brings fresh nutrients and oxygen into the capsular fluid, and removes waste products. This is always important for every joint, but even more so when the blood supply to the hip has been temporarily interupted. Your chiropractor will check the SI-joint, which is probably best adjusted using an activator, and use various soft tissue techniques on the muscles of the hip, and the capsule. Personally I recommend an orthopaedic consultation as well. Two heads is always better than one. Sometimes bedrest, a splint and even traction are recommended. Good nutrition is vital at this stage. No junk food, and plenty of salads and fruit.
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