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Causes of Limp in Children
Aka: Causes of Limp in Children, Pediatric Limp Causes
- Causes: Common
- Acute Limp
- Transient Synovitis (most common)
- Contusion
- Foot foreign body
- Fracture
- Osteomyelitis
- Septic Arthritis
- Reactive Arthritis
- Lyme Arthritis
- Poor shoe wear
- Chronic Limp
- Rheumatic disease (e.g. Dermatomyositis, Rheumatic Fever, Inflammatory Bowel Disease, SLE, Juvenile RA)
- Apophysitis (e.g. Osgood-Schlatter Disease, Sever's Disease) and other overuse syndromes
- Slipped Capital Femoral Epiphysis (esp. boys at 14 to 16 years old)
- Legg-Calve-Perthes Disease (esp. boys at ages 4 to 9 years old)
- References
- Fischer (1999) J Bone Joint Surg Br 81(6): 1029-34 [PubMed]
- Causes: LIMPSS Mnemonic
- Legg-Calve-Perthes Disease (Femoral Head Avascular Necrosis)
- Especially in males, 4-9 years old with Hip Pain and reduced range of motion (84% unilateral)
- Infection or Inflammation
- Examples: Cellulitis, Osteomyelitis, Septic Hip, Transient Synovitis
- Malignancy
- Examples: Ewing's Sarcoma and Osteosarcoma represent 90% of Bone Cancers in children; Also ALL
- Pain from Trauma
- Consider Toddler's Fracture, Non-accidental Trauma
- Slipped Capital Femoral Epiphysis (SCFE)
- Especially Overweight, black or hispanic boys (14-16 yo) more than girls (11-13 yo) with Hip Pain (90% unilateral)
- Somewhere Else (referred pain)
- Examples: Appendicitis or psoas abscess, Discitis
- Girls: UTI, Ectopic Pregnancy, Ovarian Torsion, Pelvic Inflammatory Disease
- References
- Jhun and Raam in Herbert (2016) EM:Rap 16(2):15-6
- Causes: Age 1-5 years
- See Common causes for all ages as above
- Acute
- Hip and Leg
- Toxic or Transient Synovitis (most common)
- Toddler's Fracture
- Tibial Stress Fracture
- Septic Hip
- Henoch-Schonlein Purpura (esp. Polyarthritis at ankles and knees)
- Foot
- Hand Foot and Mouth Disease
- Systemic
- Non-Accidental Trauma in Children (Child Abuse)
- Salter Fracture Type 1
- Immunizations (local reaction may cause limp due to affected injected leg)
- Chronic
- Hip
- Congenital Hip Dysplasia (most common, esp girls)
- Foot
- Clubfoot
- Kohler Bone Disease
- Vertical talus
- Spine
- Diskitis
- Systemic
- Cerebral Palsy
- Leg-length discrepancy
- Juvenile Rheumatoid Arthritis (or Systemic Juvenile Idiopathic Arthritis)
- Causes: Age 5-12 years
- See Common causes for all ages as above
- Acute
- Myositis
- Salter Fracture Type 1
- Chronic
- Hip
- Legg-Calve-Perthes Disease (most common, esp. boys)
- Foot
- Kohler Bone Disease
- Tarsal Coalition
- Spine
- Spinal Dysraphism with Tethered Cord
- Systemic
- Acute Rheumatic Fever
- Muscular Dystrophy
- Dermatomyositis
- Juvenile Rheumatoid Arthritis (or Systemic Juvenile Idiopathic Arthritis)
- Leukemia
- Causes: Ages 11-19 years
- See Common causes for all ages as above
- Acute
- Soft Tissue Injury (Ligament Sprain, Tendon Strain)
- Tendinopathy
- Overuse syndrome
- Chronic
- Hip
- Slipped Capital Femoral Epiphysis (most common, esp. boys)
- Legg-Calve-Perthes Disease (esp. boys)
- Knee
- Osgood-Sclatter Disease or Chondromalacia petellae
- Osteochondritis Dissecans of the Knee
- Discoid meniscus
- Foot
- Tarsal Coalition
- Spine
- Spinal Dysraphism with Tethered Cord
- Spondylolisthesis
- Lumbar Disc Herniation
- Scoliosis
- Systemic Arthritis
- Juvenile Rheumatoid Arthritis (or Systemic Juvenile Idiopathic Arthritis)
- Systemic Lupus Erythematosus
- Inflammatory Bowel Disease
- Miscellaneous
- Tumor
- Hypermobility Syndrome
- Causes: Hematology and Oncology
- Sickle Cell Anemia (causes osteonecrosis)
- Henoch-Schonlein Purpura
- Benign Neoplasm
- Osteoblastoma
- Osteoid Osteoma
- Bone cyst
- Malignant Neoplasm
- Ewing Sarcoma
- Leukemia
- Osteosarcoma
- Spinal cord tumor
- Metastatic cancer to bone
- Causes: Congenital and Developmental Disorders
- Congenital deformity
- Clubfoot
- Short femur or other Limb Length Discrepancy
- Congenital Hip Dysplasia
- Discoid lateral meniscus
- Developmental bone disorder (see age specific causes as above)
- Slipped Capital Femoral Epiphysis (SCFE)
- Legg-Calve-Perthes Disease
- Blount's Disease (Tibia Vara)
- Tarsal Coalition
- Neuromuscular disorders
- Cerebral Palsy
- Developmental Delay
- Spasticity or hypertonia
- Asymmetric motor activity or Deep Tendon Reflexes
- Muscular Dystrophy
- Spinal Dysraphism (e.g. Myelomeningocele)
- Causes: Infection
- Osteomyelitis
- Transient Synovitis (follows Group A Streptococcus or Viral Infection)
- Septic Arthritis
- Lyme Disease
- Meningitis (especially Meningococcus)
- Soft tissue abscess or Cellulitis
- Pyomyositis
- Discitis or Vertebral Osteomyelitis (esp. Lumbar Spine in young children)
- Subtle presentation (focal tenderness and preference for supine position may be only findings)
- Spinal Epidural Abscess
- Acute Appendicitis or other intra-abdominal infection
- Infectious Myositis
- Viral Myositis
- Influenza (esp. affecting calf Muscles, with "Charlie-Chaplain shuffle" with Out-toeing)
- Bacterial Myositis (pyomyositis), with focal infection (esp. upper thigh or deep Pelvis)
- May be associated with underlying Osteomyelitis
- Causes: Musculoskeletal
- Fracture, Trauma or overuse
- Osteochondritis Dissecans (overuse injury)
- Pediatric Fractures or Stress Fractures (consider Child Abuse)
- Intra-articular injury or Hemarthrosis (may also be caused by Hemophilia)
- Patellofemoral Syndrome (Chondromalacia Patellae)
- Soft tissue foreign body (e.g. foot)
- Apophyseal Injury
- Osgood-Schlatter Disease (tibial tuberosity Apophysitis)
- Sever Disease (Calcaneal Apophysitis)
- Sindig-Larsen-Johansson Disease (inferior Patellar Apophysitis)
- Rheumatologic Conditions (chronic systemic symptoms and bilateral symmetric or multifocal findings)
- Acute Rheumatic Fever
- Juvenile Rheumatoid Arthritis
- Dermatomyositis or Polymyositis
- Reactive Arthritis or Spondyloarthropathy
- Systemic Lupus Erythematosus
- Transient Synovitis
- Henoch-Schonlein Purpura
- Causes: Miscellaneous
- Referred intra-Abdominal Pain
- Appendicitis or other psoas abscess
- Neuroblastoma
- Neurologic causes
- Peripheral Neuropathy
- Spinal cord lesion or compression
- Non-Organic
- Growing Pains
- School Phobias
- Conversion Disorder
- References
- Gardiner (2018) Crit Dec Emerg Med 37(5): 3-14
- Fischer (1999) J Bone Joint Surg Br 81(6): 1029-34 [PubMed]
- Flynn (2001) J Am Acad Orthop Surg 9(2): 89-98 [PubMed]
- Naranje (2015) Am Fam Physician 92(10): 908-16 [PubMed]
- Sawyer (2009) Am Fam Physician 79(3): 215-24 [PubMed]