What is Legg-Calve-Perthes Disease? Symptoms, Causes, & Treatment

Legg-Calve-Perthes disease is a childhood hip condition where the blood supply to the ball part of the hip joint gets temporarily interrupted. This interruption causes the bone tissue in the femoral head (the ball part of your child's thighbone) to break down and then gradually rebuild itself over time.

While this might sound scary, most children with this condition can lead completely normal, active lives with proper care. The disease typically affects children between ages 4 and 10, and with patience and the right treatment approach, the hip joint often heals well.

What are the symptoms of Legg-Calve-Perthes disease?

The most common first sign is a limp that comes and goes, often without any obvious injury or fall. Your child might start limping after physical activity or by the end of a long day, but seem fine in the morning.

Here are the symptoms you might notice as the condition develops:

• Limping that becomes more noticeable over time
• Hip, groin, or thigh pain that may be mild at first
• Knee pain (which can be confusing since the problem is actually in the hip)
• Stiffness or reduced range of motion in the hip
• Pain that gets worse with activity and better with rest
• One leg appearing shorter than the other
• Muscle weakness or wasting in the thigh

The tricky thing about this condition is that symptoms often develop gradually. Your child might not complain much about pain initially, which is why the limp is usually the first clue that something needs attention.

What causes Legg-Calve-Perthes disease?

The exact cause of Legg-Calve-Perthes disease remains unknown, but we know it happens when blood flow to the femoral head gets disrupted. Think of it like a temporary power outage to that specific area of bone.

Several factors may contribute to this blood flow interruption:

• Abnormal blood clotting that blocks small blood vessels
• Injury to blood vessels from repeated minor trauma
• Genetic factors that affect blood vessel development
• Inflammation that damages blood vessels in the hip
• Hormonal influences during growth periods

In rare cases, certain conditions might increase the risk. These include blood disorders like sickle cell disease, steroid use, or other conditions that affect blood circulation. However, most children who develop Legg-Calve-Perthes disease are otherwise completely healthy.

What's important to understand is that this isn't something you or your child did wrong. It's not caused by too much activity, a specific injury, or anything preventable in most cases.

When to see a doctor for Legg-Calve-Perthes disease?

You should contact your child's doctor if you notice persistent limping that lasts more than a few days, especially if there was no clear injury. Even if your child isn't complaining of pain, unexplained limping needs medical evaluation.

Seek medical attention promptly if your child experiences:

• Limping that gets progressively worse
• Hip, groin, or knee pain that interferes with daily activities
• Difficulty putting weight on one leg
• Trouble with activities like climbing stairs or getting out of bed
• Noticeable stiffness in the hip joint

Early diagnosis and treatment can make a significant difference in your child's long-term outcome. Don't worry about being overly cautious. It's always better to have these symptoms checked out sooner rather than later.

What are the risk factors for Legg-Calve-Perthes disease?

Certain factors make some children more likely to develop this condition, though having risk factors doesn't mean your child will definitely get the disease. Understanding these can help you know what to watch for.

The most common risk factors include:

• Age: Most common between ages 4 and 10, with peak occurrence around age 6
• Gender: Boys are about 4 to 5 times more likely to be affected than girls
• Race: More common in Caucasian children
• Family history: Having relatives with the condition increases risk slightly
• Small stature for age
• Delayed bone age compared to chronological age
• Low birth weight

Some environmental and medical factors may also play a role, though these are less common. These include exposure to secondhand smoke, certain medications, or underlying blood clotting disorders.

Remember that most children with risk factors never develop the condition. These factors simply help doctors understand who might be more susceptible.

What are the possible complications of Legg-Calve-Perthes disease?

While many children recover well with proper treatment, it's natural to wonder about potential long-term effects. The good news is that serious complications are relatively uncommon, especially with early diagnosis and appropriate care.

Possible complications can include:

• Hip arthritis later in adulthood (though this may not occur for decades)
• Permanent changes in hip joint shape
• Leg length difference that persists into adulthood
• Reduced range of motion in the affected hip
• Need for hip replacement surgery in adulthood (in severe cases)

The risk of complications depends largely on your child's age when the disease begins and how much of the femoral head is affected. Children who are younger when diagnosed typically have better outcomes because their bones have more time and capacity to remodel and heal.

Your orthopedic specialist will monitor your child carefully throughout treatment to minimize the risk of these complications. Most children with Legg-Calve-Perthes disease grow up to be active adults with minimal or no long-term problems.

How is Legg-Calve-Perthes disease diagnosed?

Diagnosing Legg-Calve-Perthes disease starts with your doctor listening to your concerns and examining your child's hip movement and walking pattern. They'll check for pain, stiffness, and any differences in leg length.

The diagnostic process typically includes several imaging tests:

1. X-rays of both hips to compare the affected side with the healthy side
2. MRI scan to get detailed images of soft tissues and blood flow
3. Bone scan (rarely needed) to assess blood supply to the bone
4. Follow-up X-rays over time to monitor the disease's progression

Your doctor might also order blood tests to rule out other conditions that can cause similar symptoms. The diagnosis is usually confirmed through X-ray changes, though early in the disease, the X-rays might look normal.

Getting an accurate diagnosis can take time because the condition progresses through different stages. Your doctor will likely want to see your child for follow-up visits to track how the condition is developing.

What is the treatment for Legg-Calve-Perthes disease?

Treatment for Legg-Calve-Perthes disease focuses on protecting the hip joint while the bone heals and reforms naturally. The goal is to keep the ball part of the hip joint round and well-positioned in the socket during this healing process.

Treatment options vary based on your child's age and the severity of the condition:

• Observation with regular monitoring for mild cases
• Activity modification to reduce stress on the hip
• Physical therapy to maintain hip flexibility and strength
• Braces or casts to keep the hip in proper position
• Anti-inflammatory medications for pain relief
• Surgery in more severe cases to improve hip positioning

The healing process is slow, typically taking 2 to 4 years for the bone to fully rebuild. During this time, your child will need regular check-ups with X-rays to monitor progress.

Your orthopedic specialist will create a treatment plan specifically tailored to your child's needs. The approach may change as the condition progresses through its different stages of healing.

How to provide home care during Legg-Calve-Perthes disease?

Supporting your child at home plays a crucial role in their recovery and overall well-being. Your approach should balance protecting the healing hip while maintaining your child's normal childhood experiences as much as possible.

Here are key aspects of home care:

• Encourage low-impact activities like swimming, which is excellent for maintaining fitness
• Help your child follow activity restrictions without making them feel overly limited
• Ensure they take prescribed medications as directed
• Support physical therapy exercises at home
• Watch for signs of increased pain or difficulty walking
• Maintain open communication about how they're feeling physically and emotionally

Activities to limit during active treatment typically include running, jumping, contact sports, and activities that put high stress on the hip joint. However, your child can usually participate in many other activities with some modifications.

Emotional support is just as important as physical care. This condition can be frustrating for active children who suddenly need to limit their activities. Reassure your child that this is temporary and that they'll be able to return to their favorite activities once healing is complete.

How should you prepare for your doctor appointment?

Being well-prepared for your appointments helps ensure you get the most comprehensive care for your child. Bring a list of questions and concerns so you don't forget anything important during the visit.

Before your appointment, gather this information:

• When you first noticed symptoms and how they've changed
• Current medications and any previous treatments tried
• Family history of hip or bone problems
• Your child's activity level and any limitations they've experienced
• Questions about treatment options, activity restrictions, and long-term outlook

Don't hesitate to ask about anything that concerns you, from daily care questions to long-term prognosis. Understanding your child's condition fully helps you provide the best support at home.

It's also helpful to prepare your child for the appointment by explaining what might happen in age-appropriate terms. This can help reduce their anxiety about medical visits.

What's the key takeaway about Legg-Calve-Perthes disease?

Legg-Calve-Perthes disease, while concerning, is a condition that most children recover from well with proper care and patience. The key is early diagnosis and following your treatment plan consistently, even when progress seems slow.

Remember that healing takes time, typically 2 to 4 years, but most children go on to live active, normal lives. The younger your child is when diagnosed, the better their chances for complete recovery without long-term complications.

Stay connected with your medical team, follow activity guidelines, and provide plenty of emotional support for your child during this challenging time. With proper treatment and your loving care, your child can get through this condition and return to all the activities they enjoy.