The Causes of Limp
Limp can be broadly divided into acute and chronic and broadly categorised by age. The Table below is a helpful reminder but is not a comprehensive list of all causes. The conditions in bold are potentially life threatening and not to be missed; many of these are covered under key conditions;
- Infectious or reactive conditions: e.g., septic arthritis, osteomyelitis, rheumatic fever.
- Malignancy: e.g., leukaemia.
- Orthopaedic conditions: e.g., Legg-Calves-Perthes’ disease, Slipped upper capital Femoral epiphysis.
- Rheumatological conditions: e.g., Juvenile Idiopathic Arthritis or Juvenile Dermatomyositis.
- Metabolic conditions: e.g., Rickets.
- Neurological conditions: e.g., cerebral palsy, muscular dystrophy.
Remember to consider causes that are not directly joint or muscle related (e.g., testicular torsion / epididymo-orchitis, appendicitis / psoas abscess, inguinal hernia, urine infection).
Chronic or intermittent limp can be more diagnostically challenging than acute limp.
|
Age |
Acute limp With non-weight bearing likely. |
Chronic and insidious limp pain may be less obvious as a presenting feature |
|
1–3 years |
Septic arthritis/osteomyelitis. Rheumatic fever. Transient synovitis. Trauma / Non-accidental injury. |
Developmental dysplasia of hip. Neuromuscular disorder (e.g., cerebral palsy). Muscular dystrophy. Unequal leg length (e.g., post physeal injury or untreated inflammatory arthritis). Inflammatory joint and muscle disease. |
|
3–10 years |
Transient synovitis. Septic arthritis/osteomyelitis. Rheumatic Fever. Trauma. Perthes disease (acute). Malignant disease e.g., leukaemia. Inflammatory joint and muscle disease. |
Perthes disease. Developmental dysplasia of hip. Neuromuscular disorders, e.g., Duchenne muscular dystrophy. Inflammatory joint and muscle disease. |
|
11–16 years |
Slipped upper [Capital] femoral epiphysis (acute). Avascular necrosis of the femoral head. Inflammatory joint and muscle disease. Trauma. Septic arthritis/osteomyelitis. Rheumatic Fever. Bone tumours. |
Slipped upper [Capital] femoral epiphysis. Inflammatory joint and muscle disease. Dysplastic hip. |
Further information about limp is available.
https://www.rch.org.au/clinicalguide/guideline_index/Child_with_limp/
