Progressive Ambulation in the LCP Syndrome

To the Editor:—  Discussing treatment of juvenile osteochondrosis Legg-Calvé-Perche'sdisease (LCP), L. H. Wilk, MD, observes that although complete bed rest has been found to be excellent therapy, "it can be an almost impossible task for the parents" (JAMA192:939-946 [June 14] 1965). In cases in which both sides of the body are affected two to four years of complete bed rest are indeed most impossible. For these cases a planned progressive ambulation may be effective.As activity of the process diminishes, a tricycle with a hand-operated front wheel brake and toe clips on the pedals may be permitted. Later "four-footed" ambulation followed by periods of tip-toe walking may be permitted. Only when the patient is fully recovered can resumption of impact ambulation be permitted, with the patient using the heel of the foot in walking or the knee in crawling.One thing missed in Dr. Wilk's report was a