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Pediatric Leg Disorder
Aka: Pediatric Leg Disorder, Lower Extremity Abnormality in Children, Lower Extremity Abnormalities in Children, Pediatric Leg Evaluation
- See Also
- Causes of Limp in Children
- Abnormal Gait
- Gait Evaluation in Children
- Precautions
- See Limping Child for acute painful gait
- This Pediatric Leg Disorder topic addresses the more chronic, progressive pediatric leg abnormalities
- History
- Distinguish between 2 types of Gait Abnormality (critical first step)
- Acute, Antalgic Gait (painful) resulting in Limping Child (urgent evaluation)
- See Limping Child
- Chronic, progressive, nonantalgic gait or other leg abnormality
- Described here
- Past medical history and growth and development
- Prenatal and birth history
- Developmental Milestones
- Exam: Systemic Signs
- Growth
- Height and weight with growth percentiles
- Normal growth decreases likelihood of underlying systemic condition (e.g. Rickets, metabolic bone disease)
- Facial Appearance
- Abnormal facies may suggest genetic disorder
- Neurologic
- See Developmental Delay
- See Muscle Weakness in Children
- Skin
- Ecchymosis
- Nonaccidental Trauma
- Midline spinal skin changes (e.g. dermal sinus, midline Lipoma, sacral dimple)
- See Cutaneous Signs of Dysraphism
- Neurocutaneous Syndrome (e.g. Cafe-Au-Lait Macule)
- See Neurofibromatosis
- Exam: Gait
- See Gait Evaluation in Children
- Distinguish between painful (antalgic) and non-painful (nonantalgic) Abnormal Gait
- Antalgic Gait
- Stance phase on unaffected limb is shortened due to pain
- Refusal to bear weight especially with limited range of motion, systemic symptoms, fever
- Septic Arthritis
- Nonantalgic gait
- See Abnormal Gait
- Includes Steppage Gait, Trendelenburg Gait, Circumduction Gait, Equinus Gait
- Exam: General Musculoskeletal
- Joint Inflammation (Joint Swelling, warmth, and painful range of motion)
- Inflammatory Arthritis
- Septic Arthritis (non-weight bearing)
- Reactive Arthritis
- Muscle
- Muscular atrophy: Disuse atrophy or neurologic disorder
- Calf hypertrophy: Muscular Dystrophy
- Ligaments
- Joint Laxity
- Bone Tenderness
- Fracture or bone Contusion
- Bone Tumor (may present with palpable bone mass)
- Osteomyelitis
- Spine
- Evaluate spinal flexion and extension
- Evaluate for Scoliosis, lumbar lordosis, thoracic kyphosis
- Exam: Hip and Pelvis
- See Hip Exam
- See Hip Rotation Evaluation in Children
- See Hip Range of Motion
- Gluteal or thigh skin fold asymmetry
- Congenital Hip Dysplasia
- Galeazzi Sign
- Limb Length Discrepancy
- FABER Test or Pelvic Compression Test positive
- Sacroiliac Joint Disorder
- Trandelenburg Test positive
- Congenital Hip Dysplasia, weak hip adductors
- W-Sitting Position
- Associated with Femoral Anteversion
- Patient sits on floor with each heel adjacent to the ipsilateral hip
- Hips flexed and externally rotated
- Knees maximally flexed
- Hip resting position flexed and externally rotated
- Slipped Capital Femoral Epiphysis
- Hip unable to be abducted or internally rotated
- Hip Joint effusion
- Hip abducted
- Hip internal rotation lost
- Aseptic Necrosis of the Femoral Head
- Slipped Capital Femoral Epiphysis
- Intraarticular hip disorder
- Pelvic compression resulting in pain
- Sacroiliac joint disorder
- Pelvis Trauma
- Exam: Leg
- Foot Deformity
- See Pediatric Foot Evaluation
- See Gait Evaluation in Children
- See Foot Anatomy
- Consider common foot disorders
- Clubfoot (tiptoe walking, fixed equinus position)
- Metatarsus Adductus (foot cause of In-Toeing)
- Calcaneovalgus Deformity (Out-toeing)
- Rotational Deformity
- Torsional Profile (Leg Rotation Evaluation in Children)
- Foot Progression Angle (In-Toeing, Out-toeing)
- Thigh-Foot Angle (tibial torsion)
- Hip Rotation Evaluation in Children (Femoral Anteversion)
- Angular Deformity
- Nearly all newborns start with Genu Varum
- Neutral position by age 2 years
- Genu Valgum by age 3-6 years
- Returns to neutral or slightly valgus position (esp girls), by age 7-11 years old
- Evaluate standing knee alignment
- Intercondylar distance
- Intermalleolar distance
- Tibiofemoral angle
- Disorders
- Genu Varum (bow leg)
- Genu Valgum (knock knee)
- Differential Diagnosis
- Acute, Antalgic Gait (painful) resulting in Limping Child
- See Causes of Limp in Children
- See Leg Pain
- See Foot Pain
- Chronic, progressive, nonantalgic gait or other leg abnormality
- See Gait Evaluation in Children
- See Abnormal Gait in Children
- See In-Toeing
- See Out-toeing
- References
- Rerucha (2017) Am Fam Physician 96(4): 226-33 [PubMed]