Limp

Limp, defined as an uneven, jerky, or difficult gait, is one of the most common presentations of musculoskeletal disease in children.

The cause of a limp in a child can range from something as minor as a blister on a toe or something as serious as a life-threatening bone tumor. Therefore it should be investigated early to make sure no serious problems are present.

What are the causes for a limp in a child?

The causes of limp can be described by age – the following are just some of the possible causes for limping in children:

Toddlers (1 – 3 years of age)

o  Trauma

~ Toddlers fracture


- involves the tibia (large bone of the lower leg)
- typically seen in kids 9 months to 3 years
- usually involves only minor trauma

~ Puncture wounds

- from stepping on a sharp object

~ Lacerations

o  Infections

~ Septic arthritis

- a serious bacterial joint infection

~ Osteomyelitis

- a serious bacterial bone infection

o  Tumor

o  Cerebral palsy

o  Toxic synovitis of the hip

- the most common form of arthritis in children

- inflammation of the joint lining occurs suddenly, usually follows
a viral respiratory tract infection and resolves on its own
without any long lasting problems

- boys are affected 4 times more than girls

- if fever is present, it is low-grade (< 101F)

- the child may complain of hip, thigh or knee pain

- it is a diagnosis of exclusion, which means that it is diagnosed
when other, more serious conditions, have been ruled out.

- nonsteroidal anti-inflammatory medications (NSAIDS) such as
ibuprofen to reduce the pain is usually the only treatment
needed

Children (4-10 years of age)

o  Trauma

o  Infections

o  Arthritis

o  Toxic synovitis

o   Legg-Calve-Perthes disease

- Hip disease in children usually 4 – 8 years of age

- Probably due to poor blood supply to the top of the long thigh
bone (femur) where it inserts into the hip

- Males are affected 4 – 5 times more often than females

- Pain is typically referred to the knee

Adolescents (older than 11 years of age)

o  Trauma

Sprains and strains

~ Laceration

Fractures

o  Arthritis

o  Slipped capital femoral epiphysis

- Hip disorder usually seen during a growth spurt

- Involves a break at the top of the long thigh bone (femur) where it
inserts into the hip

- Most common in obese adolescents

- Limp with hip or knee pain

- A surgical emergency

o  Tumor

o  Differences in leg length

o  Osgood-Schlatter disease

- Most common in males age 11 – 15 who are active in sports

- Inflammation to a small part of the top of the large bone in the
lower leg (tibia) where the patella (knee cap) tendon attaches

- Only treatment needed in most cases is limitation of activity

What questions might the doctor ask me concerning my child’s limp?

  1. When was the limp first noticed?
  2. Has it worsened over time?
  3. Does your child have fever or any other signs or symptoms in addition to the limp (e.g., weight loss, rash)?
  4. Was there a recent viral infection before the onset of limp?
  5. Was an antibiotic used before the onset of limp?
  6. Was there a fall or any type of injury before the limp was noticed?
  7. Is there any early morning stiffness? (this could indicate arthritis)
  8. Is there any pain associated with the limp and if so where?
  9. Is your child awakened at night in pain?
  10. Does your child have back or joint pain?
  11. Is swelling noted in any of the joints?
  12. Do any of the leg joints “lock up”?
  13. Is there pain aggravated by activity? (may be due to over-use syndromes or stress fractures)
  14. Is there pain that is eased with activity? (this may suggests inflammation as seen with arthritis)
  15. Has there been new footwear or a change in the amount of walking or running?
  16. Is there a recurrent pattern with the limp (i.e. does it come and go)?
  17. Is there any family history of arthritis?

How will a doctor evaluate a child with a limp?

The most important first step will be taking a detailed history and performing a thorough physical examination.

Depending on the physician’s impression, several different tests may be performed to make a conclusive diagnosis. Some of these tests may include the following:

  • Blood tests to look for inflammation or infection
  • Xrays of one or more bones and joints
  • Ultrasound of the hip
  • Bone scano  a nuclear scanning test used to evaluate damage to the bones, detect cancer in a bone and monitor conditions that can affect the bones (including infection and trauma).o  a bone scan can often detect a problem days to months earlier than a regular x-ray test.
  • Place a needle in a joint to collect and test the joint fluid

How will a child with a limp be treated?

This of course will depend on which of the many causes of limp in children is actually the problem.

Injuries: Depending on the age of the child, certain injuries may require just ice, rest, and ibuprofen (e.g., ankle sprain) while others may require a splint or cast or even surgery (e.g., fracture).

Arthritis: Certain inflammatory conditions will only require rest and ibuprofen (e.g., toxic synovitis) while others may require long-term medication therapy (e.g., juvenile arthritis).

Infection: Serious conditions such as septic arthritis and osteomyelitis at a minimum will require antibiotics in the hospital and possibly surgery as well.

When should I call my pediatrician concerning a limp in my child?

  • It is best to call for specific instructions when you first notice that your child has a limp.
  • You should also call your doctor immediately if your child’s symptoms worsen such as high fever, increasing pain or worsening limp.