International Orthopaedics

, Volume 36, Issue 6, pp 1235–1241 | Cite as

Pathological gait in children with Legg-Calvé-Perthes disease and proposal for gait modification to decrease the hip joint loading

  • Martin Švehlík
  • Tanja KrausEmail author
  • Gerhard Steinwender
  • Ernst B. Zwick
  • Wolfgang E. Linhart
Original Paper



Legg-Calvé-Perthes disease (LCP) severely limits the range of hip motion and hinders a normal gait. Loading of the hip joint is a major consideration in LCP treatment. The aim of this study was to evaluate gait patterns in LCP and identify gait modifications to decrease the load on the affected hip.


Forty children with unilateral LCP were divided into three groups based on the time base integral of the hip abductor moments during single stance on the affected side acquired during instrumented 3D gait analysis. X-rays of the affected hip were classified according to Herring and Catterall.


Children in the “unloading” group spontaneously adopted a Duchenne-like gait with pelvis elevation, hip abduction and external rotation during single support phase. The “normal-loading” group showed pelvis elevation with a neutral hip position in the frontal plane. In the “overloading” group the pelvis dropped to the swinging limb at the beginning of stance accompanied by prolonged hip adduction. The time base integral of the hip abductor moments during single stance correlated positively with the X-ray classifications of Herring and Catterall, hip abduction angle and age. Older children preferred to walk in hip adduction during single stance, had more impaired hips and tended to overload them.


The hip overloading pattern should be avoided in children with LCP. Gait training to unload the hip might become an integral component of conservative treatment in children with LCP.


Abductor Muscle Single Support Phase Gait Pathology Stance Limb Single Stance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The study was supported by the scientific funds of the state of Styria, Austria.


  1. 1.
    Tachdjian MO (2002) Tachdjian’s pediatric orthopeadics. Saunders, PhiladelphiaGoogle Scholar
  2. 2.
    Naumann T, Kollmannsberger A, Fischer M, Puhl W (1992) Ultrasonographic evaluation of Legg-Calve-Perthes disease based on sonoanatomic criteria and the application of new measuring techniques. Eur J Radiol 15(2):101–106PubMedCrossRefGoogle Scholar
  3. 3.
    Westhoff B, Petermann A, Hirsch MA, Willers R, Krauspe R (2006) Computerized gait analysis in Legg Calve Perthes disease—analysis of the frontal plane. Gait Posture 24(2):196–202PubMedCrossRefGoogle Scholar
  4. 4.
    Stolk J, Verdonschot N, Huiskes R (2001) Hip-joint and abductor-muscle forces adequately represent in vivo loading of a cemented total hip reconstruction. J Biomech 34:917–926PubMedCrossRefGoogle Scholar
  5. 5.
    Plasschaert VF, Horemans HL, de Boer LM, Harlaar J, Diepstraten AF, Roebroeck ME (2006) Hip abductor function in adults treated for Perthes disease. J Pediatr Orthop B 15(3):183–189PubMedCrossRefGoogle Scholar
  6. 6.
    Daniel M, Herman S, Dolinar D, Iglič A, Sochor M, Kralj-Iglič V (2006) Contact stress in hips with osteonecrosis of the femoral head. Clin Orthop Relat Res 447:92–99PubMedCrossRefGoogle Scholar
  7. 7.
    Roposch A, Mayr J, Linhart WE (2003) Age at onset, extent of necrosis, and containment in Perthes disease. Results at maturity. Arch Orthop Trauma Surg 123(2–3):68–73PubMedGoogle Scholar
  8. 8.
    Herring JA, Kim HT, Browne R (2004) Legg-Calve-Perthes disease. Part I: classification of radiographs with use of the modified lateral pillar and Stulberg classifications. J Bone Jt Surg 86-A(10):2103–2120Google Scholar
  9. 9.
    Catterall A (1989) Legg-Calve-Perthes disease. Instr Course Lect 38:297–303PubMedGoogle Scholar
  10. 10.
    Ramakrishnan HK, Kadaba MP (1991) On the estimation of joint kinematics during gait. J Biomech 24(10):969–977PubMedCrossRefGoogle Scholar
  11. 11.
    Schutte LM, Narayanan U, Stout JL, Selber P, Gage JR, Schwartz MH (2000) An index for quantifying deviations from normal gait. Gait Posture 11(1):25–31PubMedCrossRefGoogle Scholar
  12. 12.
    Schwartz M (2003) The reliability of the normalcy index for quantifying gait pathology. Gait Posture 18:S119CrossRefGoogle Scholar
  13. 13.
    Kamegaya M, Saisu T, Ochiai N, Hisamitsu J, Moriya H (2004) A paired study of Perthes’ disease comparing conservative and surgical treatment. J Bone Joint Surg Br 86(8):1176–1181PubMedCrossRefGoogle Scholar
  14. 14.
    Schröter J, Güth V, Overbeck M, Rosenbaum D, Winkelmann W (1999) The ‘entlastungsgang’. A hip unloading gait as a new conservative therapy for hip pain in adults. Gait Posture 9:151–157PubMedCrossRefGoogle Scholar
  15. 15.
    Yoo WJ, Choi IH, Cho TJ, Chung CY, Park MS, Lee DY (2008) Out-toeing and in-toeing in patients with Perthes disease: role of the femoral hump. J Pediatr Orthop 28(7):717–722PubMedCrossRefGoogle Scholar
  16. 16.
    Barker K, Lamb SE, Toye F, Jackson S, Barrington S (2004) Association between radiographic joint space narrowing, function, pain and muscle power in severe osteoarthritis of the knee. Clin Rehabil 18(7):793–800PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Martin Švehlík
    • 1
    • 2
  • Tanja Kraus
    • 1
    Email author
  • Gerhard Steinwender
    • 1
  • Ernst B. Zwick
    • 1
  • Wolfgang E. Linhart
    • 1
  1. 1.Pediatric Orthopaedic, Department of Paediatric SurgeryMedical University of GrazGrazAustria
  2. 2.Orthopaedic Department for Children and Adults, 2nd Faculty of MedicineCharles University PraguePrague 5Czech Republic

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