When considering Perthes disease in children, it is identified as a key diagnosis that demands early intervention and treatment among children presenting with a limp NICE CKS,NICE CKS,NICE CKS. The condition is also known as Legg-Calvé-Perthes syndrome or disease Catterall 1981Wall 1999. While the provided guidelines do not detail specific clinical features unique to Perthes disease, they emphasise the importance of specialist assessment for a child with a limp if there is uncertainty about the cause, if the cause cannot be managed in primary care, or if the child presents with a limp on multiple different occasions NICE CKS,NICE CKS,NICE CKS.
It is important to differentiate Perthes disease from other conditions. For instance, transient synovitis is typically considered in well, afebrile, mobile but limping children aged 3–9 years NICE CKS. Children outside this age range or those with red flag symptoms (such as fever, pain waking the child at night, redness, swelling, stiffness, weight loss, or inability to bear weight) require urgent specialist assessment to exclude more serious pathologies like infection or malignancy NICE CKS,NICE CKS,NICE CKS. If a child has a persistent limp with a normal initial X-ray, referral to paediatric orthopaedics or rheumatology for further investigation is indicated NICE CKS.
Key References
- CKS - Limp (childhood) - acute
- CKS - Childhood limp - acute
- CKS - Acute childhood limp
- NG62 - Cerebral palsy in under 25s: assessment and management
- NG61 - End of life care for infants, children and young people with life-limiting conditions: planning and management
- NG127 - Suspected neurological conditions: recognition and referral
- NG12 - Suspected cancer: recognition and referral
- (Catterall, 1981): Legg-Calvé-Perthes syndrome.
- (Wall, 1999): Legg-Calvé-Perthes' disease.
- (Krátký et al., 2022): [Proximal femoral varus osteotomy in Legg-Calve-Perthes disease].