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