Hip & Thigh

What It Is

Perthes disease is a condition in children that affects the "ball" part of the hip joint (the femoral head). It happens because of a temporary disturbance of the blood supply to the femoral head. Doctors do not fully understand why the blood supply is affected. Without enough blood supply the bone softens, and the round ball shape may flatten. Over time the blood supply returns and the bone heals, although the ball does not always return to a fully normal shape, especially in severe cases (Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, 2023). The hip can become painful and stiff, and pain is often felt in the groin or thigh, or sometimes at the knee.

Even though it is called a disease, it is really more of a series of stages that the hip goes through as it heals. Full recovery can take two to three years, and during this time your child will be seen regularly in clinic (Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, 2023). If the round shape of the ball is kept, the long-term outlook is likely to be good (Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, 2023).

Perthes most commonly affects children between 4 and 8 years old, although younger or older children can be affected (Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, 2023). Boys are about five times more likely to get the condition than girls (Joseph, Shah and Perry, 2023). The condition was first described more than a century ago, in 1910 (Guarniero, 2011).

Most children with Perthes will not need surgery (Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, 2023).

Perthes Disease Anatomy

The hip is a ball and socket joint connecting the thigh bone (femur) to the socket in the pelvis. It allows the leg to move. Perthes affects the ball part of the joint, the femoral head, at the top of the thigh bone (Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, 2023). Because children are still growing, the hip continues to grow and remodel over time.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Perthes Disease

1. Pain Relief

Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (2023) says that if a child is struggling with pain, they may need simple painkillers such as paracetamol or anti-inflammatory medicines. Your child's doctor will advise which medicine is safe for your child to take. (This medicine information comes from Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before giving your child any medicine.)

2. Physical Therapy

Children with Perthes may walk with a limp because of pain and stiffness in the hip. A physiotherapist will usually provide advice and exercises to strengthen and restore movement around the hip, which may include hydrotherapy (exercise in a warm pool). This often helps with pain. If pain is bad, your child may need crutches for a while, but these are not needed routinely, and normal walking is encouraged once the pain improves (Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, 2023).

Within the limits your child's medical team sets, I can support this with gentle hands-on work and exercises to keep the hip moving and the muscles around it strong. See the My Approach tab for how I work.

3. Activity Changes

During the early stages, children are usually advised to avoid impact activities such as running and jumping, to help prevent further flattening of the ball of the hip. Non-impact activities such as swimming or supervised cycling may be fine if your child's doctor and physiotherapist are happy. Your doctor will advise on a gradual return to normal sports as the hip heals (Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, 2023).

Treatments you may want to discuss with your family doctor, nurse practitioner or medical team

Options outside my scope

Casts or braces: casts or braces that hold the legs apart (such as Petrie casts) have been used to help keep the ball of the hip within the socket, but the evidence on how well braces work is mixed (Joseph, Shah and Perry, 2023).
Surgery: in more severe cases, an operation may be offered to help restore movement, ease pain or improve the shape of the hip. Options include a femoral osteotomy (changing the position of the ball so it fits the socket better), a pelvic osteotomy (changing the position or shape of the socket to cover the ball) and releasing tight muscles around the hip (Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, 2023). If your child has an operation, follow the surgical team's own instructions for recovery.

How I can help (see the My Approach tab)

Gentle hands-on work for a stiff hip and tight muscles
Play-based strength work and home exercises, within the team's limits
Recovery support after a cast or surgery, once the surgeon agrees

Tips

In a small number of cases, the condition runs in families (Joseph, Shah and Perry, 2023).
Even though the condition can affect children of different ages, it most commonly occurs in 4 to 8 year olds (Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, 2023).
Avoid high-impact activities like jumping or running while the condition is active, as advised by your child's doctor. Gentle, low-impact activity is far better (Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, 2023).
In around 10 percent of cases, the other hip is also affected (Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, 2023).

Treatment

My Approach

With Perthes, your child's medical team leads the care. They decide which activities to avoid and whether crutches, a cast or surgery are needed. I work within those limits to keep the hip moving, ease tight or overworked muscles and help your child stay strong. Massage can't change the shape of the hip, but it can help with the stiffness and aches.

Please bring any X-ray or scan reports and notes from your child's medical team to the first visit. They're an important part of planning safe treatment for your child.

I assess how your child walks and moves, and check what they've been cleared to do. Parents are welcome to sit in, with your child's agreement. Any work around the hip and buttock needs your informed consent and a signed consent form.

Supporting the Hip

Gentle hands-on work and warm applications for tight muscles around the hip, thigh and back, never forcing the hip
Gentle movement to help keep the hip moving, within the team's limits
Play-based strength work and low-impact activity such as swimming once the team is happy, with home exercises I'll show you how to do with your child
Setting up crutches if your child needs them for a while, and practising normal walking as the pain eases

After a Cast or Surgery

I need the surgeon's okay before any hands-on treatment
Easing the other leg, back and shoulders, gentle lymphatic drainage for swelling, and scar work once the wound has healed
Care for parents and caregivers too, such as neck or back strain from lifting and carrying your child

What to Expect

Typical Course

Typical course: Usually children come once or twice a week at first, then weekly, then every few weeks as you take over the home exercises, with a reassessment at about 4 to 6 weeks. Full recovery can take two to three years, so my care follows the medical team's plan through each stage.

What I Focus On

Working Within the Medical Team's Plan

Hip Movement

Compensation Relief

Strength Through Play

Caregiver Support

Sources

References

Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (2023) Perthes disease. Available at: https://www.rjah.nhs.uk/media/4arhgtcs/perthes-leaflet-print-leaflet-2023.pdf (Accessed: 7 October 2026).
Joseph, B., Shah, H. and Perry, D.C. (2023) 'Epidemiology, natural evolution, pathogenesis, clinical spectrum, and management of Legg–Calvé–Perthes', Journal of Children's Orthopaedics, 17(5), pp. 385–403. doi: 10.1177/18632521231203009
Guarniero, R. (2011) 'Legg-Calvé-Perthes disease: 100 years', Revista Brasileira de Ortopedia, 46(1). doi: 10.1016/S2255-4971(15)30167-1

Massage therapy · Kitchener–WaterlooPerthes Disease

What It Is

Perthes Disease Anatomy

Self-Care & Treatment

How to Treat Perthes Disease

1. Pain Relief

2. Physical Therapy

3. Activity Changes

Treatments you may want to discuss with your family doctor, nurse practitioner or medical team

Tips

My Approach

Supporting the Hip

After a Cast or Surgery

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooPerthes Disease

What It Is

Perthes Disease Anatomy

Self-Care & Treatment

How to Treat Perthes Disease

1. Pain Relief

2. Physical Therapy

3. Activity Changes

Treatments you may want to discuss with your family doctor, nurse practitioner or medical team

Tips

My Approach

Supporting the Hip

After a Cast or Surgery

Typical Course

References

Related Conditions

Compartment Syndrome – Thigh/Buttocks

Developmental Dislocation (Dysplasia) of the Hip (DDH)

Femoral Anteversion

Femoral Fracture

Book a session