Limping

Children limp for a huge number of reasons, but with a careful history and examination it is usually apparent where the problem lies. The most common reason for a limp is of course an injury and this will be self-evident. The most important diagnosis to exclude however is infection, because it is usually easy to treat if caught early but can have serious consequences if missed. Infection is characterised by the rapid onset of pain, without a suitable injury. An inability to move a limb because of pain or an inability to bear weight is a sign of infection. A fever is an important sign but may be absent. Suspected infection needs urgent hospital investigation. Alternative important diagnoses will be picked up during the course of these investigations. A longer standing (chronic) limp also needs investigation but is usually not urgent unless there has been recent change.

The causes of a limp classically vary with age:

Toddlers

Dysplasia of the hip
Congenital leg length difference
Toddler’s fracture

Ages 4 to 10

Irritable hip
Perthes’ disease of the hip
Discoid meniscus of the knee

Ages 10 to 16

Slipped upper femoral epiphysis (SUFE)

All ages

Inflammatory arthritis
Patello-femoral dysplasia
Acquired leg length difference, eg trauma or infection
Developmental leg length difference
Neurological conditions
Chronic infection
Sarcomas

Congenital foot deformities usually present before walking and therefore before limping. Tip-toe walking, particularly unilateral or presenting after normal walking has started, requires referral to hospital. It can be a sign of cerebral palsy or other neurological or neuromuscular conditions, such as muscular dystrophy.