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Quick reference medical handouts used by Pediatric offices


Investigate the Cause of Limping


Limping in children is never normal. Its presence suggests that walking is either painful or difficult because of muscle weakness. The causes of this common childhood problem run the range from splinters in the foot to serious medical problems that could affect the youngster’s life if treatment is delayed.Physicians caring for children rely a lot on the parent’s history in determining the cause of the child’s limp. When did the limp start? How long has the child been limping? Was there an injury? Is the limp constant or does it come or go? Is it present only in the morning or at the end of the day? Are there other signs of other illnesses, such as fever, weight loss, decreased appetite, or rashes?

The most frequent cause of limping in an otherwise normal youngster is the childhood disorder "transient synovitis of the hip." It is presumed that a virus produces inflammation in the lining of the hip joint since most affected children had a mild cold before they suddenly started limping. This self-limited condition usually occurs in boys between 2 to 12 years of age (average 6 years). Typically, the child suddenly begins to complain of pain in the groin or knee at the end of the day. The next morning, the pain is so severe that the youngster refuses to walk, or walks slowly with a limp. Limited movements of the hip joint are the only findings on examination. The child is otherwise healthy and x-rays are either normal or show slight swelling of the joint capsule. Most children recover within 2-3 days but occasionally bed rest for as long as a week may be needed.

Legg-Calve-Perthes disease is a rare condition that always has to be considered when a child limps. It develops when, for unknown reasons, something happens to interrupt the blood supply to the top of the thigh (femoral) bone. This results in destruction of bone’s top causing pain when the child walks. Boys ages four to ten are five times more likely to be affected than girls. X-rays of he hip may be normal at first but repeated studies and bone scans make the diagnosis apparent. Consultation with an orthopedic surgeon is necessary because left untreated the disease can lead to serious disability. Fortunately, modern orthopedic therapy usually produces a long lasting, painless hip.

Another cause of limp in children is "slipped capital femoral epiphysis." For unknown reasons the top of the thigh (femoral) bone slides into an abnormal position causing an abnormal fit of the hip joint. It is most frequently seen in overweight male teenagers (10-15 years of age). There is often a history of slight injury and pain may be first felt at the knee, even though the condition afflicts the hip. Immediate consultation with an orthopedic surgeon is needed to prevent permanent deformity.

An leg injury is frequently blamed for limping since children are always falling, but trauma may not be the real cause. On the other hand, even a trivial fall can cause a significant sprain or fracture. While most trauma is self-evident from the physical examination, two related conditions may not be easy to recognize. The first, called a "toddler’s fracture" occurs when the younger child twists their leg, perhaps in falling, and suddenly limps or refuses to bear weight. Examination of the leg is usually normal and even x-rays show no abnormalities when taken soon after the injury. If the leg is re-x-rayed because the limp persists, evidence of a fracture appears. Another cause of limping from trauma is unfortunately, physical abuse. Occasionally the ill treatment is from a sibling or another child at daycare. X-rays show both a leg fracture and evidence of fresh or previous bony injuries elsewhere in the body.

Sprains (injuries to the ligaments that surround the joints) of the knee and ankles are common in children and will cause the youngster to protect the injured joint by limping. Athletic children are prone to these type of injuries because of overuse and inadequate pregame stretching.

An infection in a leg bone or joint will cause children to protect the painful area by limping. These youngsters, however, will usually have tenderness, swelling and redness in the skin overlying the infected area, and many times appear quite ill. Additional findings include abnormal blood tests showing an inflammatory disorder. These children need immediate hospitalization for antibiotics to prevent serious damage to the involved bone or joint.

Rheumatoid arthritis may begin at any age but is rare in children under the age of two. This chronic condition usually causes a recurrent limp and there is frequently a past history of unexplained rashes and fever.

Pediatric textbooks describe additional rare causes of limping in children. Included in the list are such chronic conditions as rheumatoid arthritis, blood disorders like sickle cell anemia, and neuromuscular ailments causing muscle weakness. Most of these illnesses are rare and can be excluded after a good history and a complete physical by your child’s physician.

Parents worry when they see their child limping. The cause of the abnormal walk could be something simple, like a blister on the foot or a sprained ankle. On the other hand, a child who limps could have a more serious medical disorder and parents should seek medical attention for this common childhood problem.

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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