Perthes disease, also known as Legg-Calvé-Perthes disease, is a rare condition that affects children between the ages of three and 11 years. It is a hip disorder where the blood supply to the ball of the hip joint (femoral head) is temporarily disrupted, leading to bone death and potential deformity. Perthes disease is five times more common in boys than in girls.
There are two main types of perthes disease –
• Classic Type:
It is most common type of this disease. Mostly it affects boys aged 4-8.
• Atypical Type:
It is usually less common to happen. It may occur in older children or girls.
The lack of blood supply to the femur, results in a number of changes in the bone structure that show up in four clear stages.
• Necrosis: During this early stage, lasting for several months, the bone cells of the affected area die.
• Fragmentation: Occurring over a period of 1 to 2 years, the body replaces its dead bone with a softer one. This bone, being weaker, may fracture or become distorted easily.
• Re-ossification: In this longest stage, lasting for a few years, stronger new bone cells begin to grow in the femoral head.
• Healed: The bone growth is complete, with the femoral head attaining its final shape.
Symptoms of perthes disease includes –
• Persistent hip or groin pain, often mild at first.
• Limping or favoring one leg.
• Limited range of motion in the hip.
• Thigh muscle atrophy.
• Joint stiffness.
The cause of Legg-Calve-Perthes disease is currently unknown.Legg-Calve-Perthes disease occurs when too little blood is supplied to the ball portion of the hip joint (femoral head). Without enough blood, this bone becomes weak and fractures easily. The cause of the temporary reduction in blood flow to the femoral head remains unknown. Still some of the factors that causes such condition –
• Vascular Insufficiency:
Reduced blood flow to the femoral head.
• Genetic Predisposition:
Family history may increase the risk.
Injury might contribute in some cases.
Risk Factors –
Risk factors for Legg-Calve-Perthes disease includes –
• Age and Gender:
More common in boys aged 4-8.
Family history of hip disorders.
More prevalent in Caucasians.
Complications of Perthes disease could be –
• Joint Deformity:
Over time, the femoral head may reshape abnormally.
Increased risk later in life.
• Leg Length Discrepancy:
Growth differences between affected and unaffected hips.
• Physical Examination:
Assessment of hip movement and signs of discomfort.
• Imaging Studies:
X-rays to visualize changes in the hip joint.
MRI for detailed images of blood supply.
• Conservative Management:
Rest and limited weight-bearing.
Physical therapy to maintain joint mobility.
Use of braces to keep the hip in the proper position.
In severe cases, surgical interventions like osteotomy or joint replacement may be considered.
Follow-up Care –
• Regular Monitoring:
Periodic imaging to assess hip development.
• Activity Modification:
Adjusting activities to prevent excessive strain on the hip.
Ayurvedic Management –
The disease manifestation is explained as a blockage in the channels and it causes dryness or lack of nourishment in the bone as well as joints which can lead to a degeneration.
Ayurveda treatments to remove the blockage, ‘Ama’ and giving proper nourishment through improving the circulation is suggestive and effective in the management of conditions like Perth’s Disease etc.
‘Vata’ Vitiation in the ‘Asthi’ dhatu can be corelated to the condition and Vata balancing treatment also significant in the later stage of management for strengthening the bone and joints after the correction of the blockage or Ama.
The Ayurvedic treatment of Legg-Calve-Perthes disease is aimed at controlling pain, restoring normal structure coming from the hip joint and preventing long-term deformity.
Medicines variety Panchtikta Ghrit Guggulu, Lakshadi Guggulu, Tryodashang Guggulu, Shring Bhasma, Praval Panchamrit, Shankh Bhasma, Praval Bhasma and herbs like Asthishrunkhala (Cissus quadrangularis), Laksha (Purified wax), Guduchi (Tinospora cordifolia), Amalaki (Emblica officinalis), Musta (Cyperus rotundus) and Gokshura (Tribulus terrestris) are accustomed to remold the hip cuboid.
Medicines like Triphala-Guggulu, Yograj-Guggulu, Maha-Rasnadi-Guggulu, Vat-Gajankush-Ras, Maha-Vat-Vidhwans-Ras, Tagar (Valeriana wallichii) and Nirgundi (Vitex negundo) are accustomed to treat pain and inflammation into the hip joint.
• Favorable Outlook:
Many children recover fully with appropriate treatment.
• Long-term Monitoring:
Continued follow-up into adulthood to monitor hip health.
In conclusion, Perthes disease presents unique challenges, particularly in childhood, affecting the hip joint’s blood supply. Early detection, proper diagnosis, and timely intervention are crucial for managing symptoms and preventing long-term complications. Parents and caregivers should be vigilant for signs of hip discomfort in children, and medical professionals play a key role in guiding treatment strategies tailored to each case.
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