Possible side effects of Perthes disease
The problem is that children suffering from Perthes disease are often not yet able to localize their pain exactly. Pain can occur locally at the hip joint, in the muscles surrounding the joint (e.g. thigh), but also in surrounding joints (e.g. knee joint).
By relieving the hip joint or compensating for the reduced function of the hip joint, other joints (e.g. knee joint) are overloaded. A limping mechanism can occur. The limitation of hip movement increases in advanced stages of the disease.
For diagnostic purposes, in addition to classic imaging procedures (such as X-rays), there is also the so-called sign of four (leg is splayed and the lower leg is crossed in front of the knee of the standing leg), which can be painful and limited in Perthes disease (no clear diagnosis by positive or negative sign of four!). The movement corresponds to external rotation, abduction and slight flexion in the hip joint. Targeted, individually tailored physiotherapy is used to achieve the best possible healing. Remaining deformities of the femoral head can be considered a risk factor for later osteoarthritis and may be an indication for surgery.
Summary
In Perthes disease, physiotherapeutic treatment/physical exercises are essential and the mobility and function of the hip joint must be maintained or restored. A child-friendly, appealing but goal-oriented exercise program should guide the child through the long-term treatment and motivate the child to get involved and enjoy participating in physiotherapy. The consultation between physiotherapist and parents is important so that the therapy can be continued consistently and effectively at home.
The prognosis of Perthes disease is difficult to predict, the course of the disease varies from individual to individual. Relief and mobilization are intended to achieve complete healing without leaving behind restrictions in movement or deformities of the femoral head.
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