The Child Who Has A Limp
Thomas S. Renshaw MD1
1 Professor of Orthopaedic Surgery and Pediatrics, Yale University School of Medicine, New Haven, CT.
A limp is defined generically as any deviation of child's walking pattern from the expected normal pattern for the child's age. Limping more commonly is unilateral than bilateral, and its many causes range in severity from malfitting shoes to highly malignant bone tumors.
Specific reasons for limping fall into one or more of three categories: pain, weakness, and structural abnormalities. An antalgic gait may be caused by such painful conditions as synovitis of a major weight-bearing joint; infection of bone, joint, or soft tissue; neoplasia; or trauma from such things as repetitive microtrauma, a torn knee cartilage, or a chronic stress fracture. Musclle weakness can result from disuse atrophy or from a neurologic or a primary muscle disease. The structural or mechanical causes include limb length inequality, joint stiffness, and articular surface deformity.
The anatomic origin of the limp may be the foot, ankle, leg, knee, thigh, hip, spine, or even the abdomen. It follows, therefore, that a careful and thorough history and physical examination are mandatory for the child who has a limp and that all of theses anatomic areas be evaluated carefully.
The history should include the duration of the limp, the child's or parents' perception of its site of origin, if possible, and whether pain is associated.
