Legg-Calvé-Perthes’ Disease
Legg-Calvé-Perthes’ disease refers to an idiopathic disorder that is marked by the osteonecrosis of the proximal femoral epiphysis, resulting in a femoral head deformity in children.
The aetiology of the condition is multifactorial with a number of genetic and environmental factors suggested as contributing to the progression of the disease.
A popular belief is that genetic factors disrupt blood supply to the femoral head and combine with environmental factors such as repetitive trauma or mechanical overloading to facilitate the onset of Legg-Calvé-Perthes’ disease in the child.
While investigating the epidemiology and demographics of Legg-Calvé-Perthes’ disease, Loder and Skopelja conducted a systematic review of 144 manuscripts that provided more information on the subject.
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At the end of the review, the authors found that there is decreased turnover in type I collagen and synthesis of type III collagen, as well as reduced levels of urinary glycosaminoglycans in the active phases of the disorder.
The findings of the study also established that Legg-Calvé-Perthes’ disease can be associated with abnormalities in the coagulation cascade, an increase in factor V Leiden mutation, low levels of protein C and/or S and decreased antithrombin activity.
The loss of congruency in the hip joint makes it essential to maintain maximal hip joint range of motion and to reduce weightbearing stress on the affected hip while allowing for pain-free ambulation of the patient.
MASS4D® foot orthotics can be successfully integrated into the long-term management of mild-to-moderate Legg-Calvé-Perthes’ disease which should include stretching exercises designed to enhance hip external rotation and abduction in extension and flexion.
A comprehensive active rehabilitation programme with the inclusion of MASS4D® foot orthotics will help in achieving optimal foot biomechanics which would consequently promote healthy postural alignment, necessary for improving hip joint range of motion.
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References:
- Kim, H. K. (2012) Pathophysiology and New Strategies for the Treatment of Legg-Calve-Perthes Disease. The Journal of Bone and Joint Surgery: April 2012, Vol. 94, No. 7, pp. 659-669. DOI: 10.2106/JBJS.J.01834
- Loder, R. T., Skopelja, E. N. (2011) The Epidemiology and Demographics of Legg-Calve-Perthes’ Disease. ISRN Orthopedics: September 2011, Vol. 2011. DOI: 10.5402/2011/504393
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