The femoral head remains in the acetabulum but moves relatively posteroinferior, as can be seen on a radiograph. From an external perspective, the most notable features are the outward rotation of the lower femur and leg, as well as the limp.
Pain occurs in the groin, medial thigh, or knee.
Decreased internal rotation of the hip as compared to the contralateral side. Endocrine factors such as hypothyroidism, panhypopituitarism, hypogonadal conditions, and renal osteodystrophy may weaken the physis. During the preadolescent or adolescent age, the growth plate is somewhat weaker. Increased shear stress may be generated by obesity, decreased femoral anteversion, or trauma. Stress fracture of proximal femur - more often occurs after skeletal maturity.