The Crutch and Sling system is the approach we used with Celine during the fragmentation stage of her Perthes Disease
journey. It evolved from the “Wait and See” approach suggested by our GP on her Perthes Disease diagnosis.
Basically it is used when the child has Perthes in one side of the hip only. The child concerned would be instructed to remain non-weight bearing on that side and the doctor who has diagnosed will have suggested either crutches or a wheelchair to do so.
|The Crutch and Sling system in action.
Celine found it hard to keep her Perthes leg off the ground at the start of using the crutches so it was suggested by a vlog viewer that we look at making a Snyder Sling to help. A Snyder Sling is basically a belt (a good quality leather belt works best) that goes around the waist. It has a loop that hangs down to support the leg that needs to remain non-weight bearing and a second loop that is meant to go over the opposite shoulder presumably to help with weight distribution and balance. However, Celine didn’t like the shoulder strap so we removed that to produce what is now becoming known as the Swanepoel Sling
by other users of the Crutch and Sling system. An alternative to the sling is a Sash (see photo below) which is a long piece of material that goes over the shoulder opposite to the Perthes leg and ends in a loop which the Perthes leg rests in. The Sash is especially suitable for situations where the child may be swimming and be wet since it dries quicker than a leather belt would.
Celine used this system from when she got dressed in the morning to when she got ready for bed in the evening. She was allowed to walk on both legs before and after those points in time. It was coupled with wearing no shoe on that foot as a further deterrent for putting it down on the ground and decorating the Perthes foot
with temporary tattoos and toe rings etc to make it look more interesting as the situation allowed.
|The Sash variant of the Sling.
The benefits of the Crutch and Sling system is that it allowed Celine to keep a reasonable amount of ROM (range of movement) in her Perthes hip and kept that hip non-weight bearing. She was able to maintain an excellent sense of balance and could race around on her crutches as fast as a non-Perthes child could run on both feet. She reached regrowth stage within a year of her Perthes Disease diagnosis and I have heard reports of other children using this system who are doing the same.
The downside to the Crutch and Sling system is that there is a slight wastage of muscle in the Perthes leg if a reasonable amount of exercising of that muscle did not occur regularly. Exercises can be as simple as using the Perthes foot to hold a pen or pencil to write or draw with, using the Perthes foot to pick up items and carry them (ie picking up toys to put away or rubbish to put in the bin) and more muscle orientated exercises which can be given to you by a physiotherapist.
Another downside is that she would often need regular breaks for long distance walking and we had to be careful not to let her overdo it. We also had to watch for strain in the non-Perthes hip and leg from the long-term weight impact being mostly on that leg even with the use of the crutches for support.