What Causes Limping in a Child
Causes Vary from Benign and Transient to Life-Threatening
Jun 23, 2009
In humans, walking ability (gait) undergoes an orderly development that is relatively complete by the age of three years; by the time a child is seven or eight years old, gait closely resembles that of an adult.
Abnormal gait can be characterized by shortening of the “stance phase” (the period of time a given foot is on the ground during walking), or by alterations in the gait pattern that don’t affect the stance phase but change other phases (i.e., swing, plant, or lift-off).
Antalgic (an-TAL-jick) gait—that which exhibits a shortened stance phase—is a type of gait that helps to decrease pain in an extremity: The less time a painful foot or leg bears weight, the less it hurts.
Antalgic gait can be due to benign, transient conditions, or it can be a sign of serious or even life-threatening problems.
Non-antalgic gaits—those that don’t decrease the stance phase—are usually due to chronic or well-established conditions and, while they may eventually require treatment, typically don’t require urgent evaluation.
Potential Causes of Limping in Children
Soft Tissue Conditions
- Congenital (tight Achilles tendon)
- Infection (cellulitis, bacterial or viral myositis [infection of muscle], abscess)
- Overuse injury (Osgood-Schlatter disease, chondromalacia patellae, “jumper’s knee)
- Trauma (foreign body [splinter, nail, etc.], sprain, strain, child abuse)
Neuromuscular Conditions
- Muscular dystrophy
- Cerebral palsy
- Meningitis
- Myelomeningocele
Spinal Conditions
- Vertebral osteomyelitis (infection of one or more vertebral bodies)
- Diskitis (infection or inflammation of intervertebral disk)
- Spinal cord tumors
Joint Conditions
- Congenital (malformed knee cartilage [e.g., discoid meniscus])
- Hemarthrosis (blood in joint from hemophilia or trauma)
- Infection (gonorrhea, Lyme disease, Staphylococcus, Streptococcus, etc.)
- Inflammation (juvenile rheumatoid arthritis, acute rheumatic fever, lupus, transient synovitis, etc.)
- Trauma (torn meniscus or articular cartilage, etc.)
Bone Conditions
- Congenital (clubfoot, developmental hip dysplasia, shortened femur)
- Developmental (Legg disease, slipped femoral capital epiphysis)
- Infection (osteomyelitis [bone infection])
- Discrepancy of limb length
- Benign neoplasm or mass (osteoblastoma, osteoid osteoma)
- Malignant neoplasm (Ewing sarcoma, leukemia, osteosarcoma)
- Osteonecrosis, or localized death of bone (sickle-cell disease)
- Overuse injury (stress fracture, osteochondritis dissecans
- Trauma (“toddler’s fracture”, child abuse)
Other
- Acute appendicitis
- Psoas abscess
- Neuroblastoma
(From Sawyer J, Kapoor M. The limping child: a systematic approach to diagnosis. Am Fam Phys 2009;79(3):215-224)
Although the most common cause of limping in uninjured children who present to emergency departments is transient synovitis (benign inflammation of the membrane surrounding a joint), the true incidence of limping in children—and the ratio of underlying causes—is unknown. (Fischer S, Beattie T. The limping child: epidemiology, assessment and outcome. J Bone Joint Surg Br 1999;81(6):1029-34)
Since a delay in diagnosis and treatment of more serious conditions can result in significant complications (or even death), any child who exhibits a persistent (more than 24 hours) or recurrent limp, who complains of persistent or recurrent pain in a lower extremity, or who is unable to bear weight on a lower extremity should undergo medical evaluation.
