There are many causes of limping in children and they can occur in any age group. It can range from a slight limp to refusal to bear weight on the leg. Most pain from trauma or overuse will respond to a night of rest or decrease in activity and over the counter anti-inflammatory medications.
There are some factors that would indicate the need to seek medical attention. One is a painless limp in any age child. This may indicate serious underlying neurologic or muscular diseases.
If a limp lasts for more than a few days, is associated with severe pain, does not respond to rest, or is associated with other symptoms such as fever, chills, or pain at rest, medical attention should be sought.
Some of the common causes of limping in children by age group are:
Walking up to 2 years:
Developmental hip dysplasia: This can occur in all age groups and is a dislocation or slipping of the ball out of the socket. In infants the hip may appear normal early on, but if left untreated will appear shorter and have less movement than the normal side. This is looked for on most visits to the pediatrician in the first four months of life. Early treatment will prevent major problems at a later age.
Septic arthritis: This is an infection of the hip joint bone surrounding the joint. The patient will usually have had an illness 2-3 weeks prior to the onset of hip pain, such as an upper respiratory cold or an ear infection. The hip joint will be held in flexed position and will be held noticeably still compared to the other leg. Any attempted movements will cause the child to cry out.
Toddler?s fracture: This usually occurs in the tibia bone of the lower leg. It is a crack in the bone near the knee from the stress of walking. Most children will begin to limp and may refuse to bear weight on the leg. The fracture may not show up for 2-3 weeks and a bone scan is sometimes necessary to confirm the diagnosis. Most will heal within 4-6 weeks of protected weight bearing.
Three to five years
Toxic synovitis: This is the most common cause of hip pain in children 3-5 years old. It will usually present as a limp and may be caused by some type of trauma. The child will usually wake up in the morning and refuse to put his foot down and walk. The child will usually not have a fever and will be able to move the hip slowly, unlike a child with an infected hip. Toxic synovitis usually resolves in a few days. The child should be seen by a doctor if the symptoms last more than a week or if fever, increasing pain or refusal to move the hip develops.
Kohler?s Disease: This is a vascular problem involving one of the bones in the foot (the tarsal navicular). It causes pain over the top of the foot with weight bearing and the child will often walk on his/her heel and keep the foot flexed up. Early treatment with a cast will usually lead to a good outcome.
Four to seven years
A painless limp in this age group may be the beginning of a more systemic disease process such as muscular dystrophy, leukemia or juvenile rheumatoid arthritis. This will often be accompanied by systemic signs such as multiple joint swelling or aching, rash, fever, chills or visual disturbances.
Legg-Calve-Perthes Disease: Although the previous problems should be considered in this age group, Legg-Calve-Perthes disease is by far the most common in this age group. The child is usually small for his age and boys are more commonly affected than girls.
Ten to fifteen years
Slipped Capital Femoral Epiphysis: This is usually caused by trauma, and is a shifting of the growth plate in the hip. The child is usually heavy for his age, and he may be involved in sports. The pain will present in the hip, groin or anterior thigh. It may also be missed in a child presenting with only knee pain. It can occur gradually with progressive pain and limp over a number of weeks, or all at once. The main symptoms are pain and loss of motion in the hip.
Slipped capital femoral epiphysis is a real emergency, and requires surgery to pin the growth plate. Failure to do so would result in a loss of blood supply to the hip, ending in severe deformity and disability.
Tarsal Coalition: This is a fusion of certain bones in the foot that is congenital in nature. It usually does not become symptomatic until early teen years and may start with a traumatic episode. Most patients will have limited motion in the foot and stiff gait.
Diagnosis usually requires special x-rays or a CT scan. Treatment consists of casting, bracing, or, occasionally, surgery to separate the fusion.
Spondylolisthesis: This is a failure of fusion of the lower vertebral bones of the back. It causes the spine to slip forward on the pelvis. Patients will present with a waddling type of limp in which the knees are flexed and the lower back appears flat. Back and thigh pain are also common.
Diagnosis can be missed unless proper x-rays are taken. Treatment consists of bracing, physical therapy, injections or possible surgery.
