Hip

Perthes Disease: Femoral Head in Children

A limping child aged 4-8 without trauma warrants evaluation, especially with hip pain or morning stiffness.

Updated: September 2026·Medically reviewed by Dr. Daniele Priano

Quick Answers

Does Perthes disease heal completely?
Prognosis depends on age at onset, extent of femoral head involvement and how early the pathway is started. Younger children, generally under 6 years, have a more favorable prognosis thanks to greater remodeling potential. With a well-conducted pathway, many children achieve good hip function, although some radiological changes may remain visible.
Can my child with Perthes play sports?
Activity is not decided by one rule for every child. Pain, hip motion, disease stage and type of sport influence permitted loading. During more symptomatic periods or when motion is being lost, high-impact activity may need reduction; progression is reassessed over time.
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A seated child pointing to the thigh and knee while the mother describes limping to the doctor.

Limping may reflect a hip problem

Perthes disease can cause limping with hip, thigh or knee pain. Sometimes pain is not obvious.

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Legg-Calvé-Perthes disease is a temporary impairment of blood supply to the femoral head, typically affecting school-age children, more often males. The femoral head goes through several phases (avascular phase, fragmentation, reossification, remodeling) over a period that can last several years. It presents with persistent limping without clear trauma, hip or referred knee pain, morning stiffness, and sometimes the child becoming reluctant to run or play as before. Diagnosis is based on clinical assessment and imaging. The pathway is built case by case and aims to protect the femoral head during the remodeling phase, keep it well 'contained' within the acetabulum, and preserve hip mobility. Most children, especially the youngest, recover well; in cases with less favorable prognosis more structured options, including surgery, are considered.

Dott. Daniele Priano - Ortopedico Pediatrico

🩺Age, stage and motion matter in Perthes disease

There is no single pathway for every child with Perthes disease. Age at onset, hip motion, radiographic stage and extent of involvement influence prognosis and treatment. Assessment also helps determine appropriate loading and activity at different stages.

Assessment and treatment

When to seek evaluation

  • Persistent limping without evident trauma
  • Hip or referred knee pain
  • Limited hip range of motion
  • Morning hip stiffness
  • Child refusing to play or run

What is evaluated

  • Clinical hip examination (ROM, abduction, rotation)
  • Bilateral hip X-rays
  • MRI in selected cases, when it changes assessment or treatment planning
  • Classification according to Catterall or Herring on plain radiographs when needed for staging; Stulberg classification is used later, to describe residual femoral head morphology as an outcome measure, not as an initial staging tool
  • Serial monitoring of evolution

Treatment options

  • Observation and physical therapy for mild cases
  • Non-surgical containment (braces, casts)
  • Femoral or pelvic osteotomy in selected cases
  • Long-term monitoring until skeletal maturity

Frequently Asked Questions

Does Perthes disease heal completely?▼
Prognosis depends on age at onset, extent of femoral head involvement and how early the pathway is started. Younger children, generally under 6 years, have a more favorable prognosis thanks to greater remodeling potential. With a well-conducted pathway, many children achieve good hip function, although some radiological changes may remain visible.
Can my child with Perthes play sports?▼
Activity is not decided by one rule for every child. Pain, hip motion, disease stage and type of sport influence permitted loading. During more symptomatic periods or when motion is being lost, high-impact activity may need reduction; progression is reassessed over time.
How long does Perthes disease last?▼
The natural course can last several years, during which the femoral head goes through successive phases of avascular impairment, fragmentation, reossification and remodeling. For this reason follow-up is repeated over time, with personalized intervals: they cover the active phase and the subsequent remodeling phase and, when indicated, may continue until skeletal maturity. Biological healing of the femoral head does not always mean complete restoration of hip morphology.
Why does Perthes occur? Is it anyone's fault?▼
The exact cause is not yet clear: it is a temporary impairment of blood supply to the femoral head, probably multifactorial (individual predisposition, vascular and mechanical factors). **It is not the parents' fault, nor due to diet or sports practiced**. No effective prevention strategies have been demonstrated.
Is Perthes hereditary?▼
There are reports of family clustering in a small proportion of cases, but in the vast majority of children Perthes occurs sporadically, with no other cases in the family. Having a sibling or parent with Perthes does not mean the child will definitely develop the disease.
What does 'containment' of the femoral head mean?▼
**Containment** means keeping the femoral head well centered and covered by the acetabulum (the 'cup' of the pelvis) during the reconstruction phase. Good coverage helps the head remodel into a more spherical shape. Depending on the case, containment is achieved through selective rest, targeted exercises, braces or, in selected cases, surgery.
Will there be hip problems in adulthood?▼
Many children grown up after Perthes have a functionally good hip as adults. In some cases, especially in more extensive forms or those diagnosed at older ages, **hip changes may appear over time** (for example a greater predisposition to early arthritis). For this reason long-term follow-up is offered, up to and beyond skeletal maturity.

Important Notice: The information on this page is for educational and informational purposes only and does not constitute medical advice. Each clinical case is unique: the appropriate treatment is determined during the specialist consultation, based on a thorough clinical examination and, where necessary, diagnostic imaging. For any doubts or concerns, please consult a specialist.