Limp is a symptom or an observation but is not a diagnosis.
Limp is defined as a deviation in walking pattern away from the expected normal pattern for the child's age. Limp is an asymmetric gait, often, but not always, due to pain.
Be aware of pitfalls in making a diagnosis in a case of limp.
This module covers differential diagnosis of limp (which is very broad).
There are several types of abnormal gait.
Conditions can range from the benign (such as a splinter in the foot) to the serious (such as Juvenile Idiopathic Arthritis (JIA), discussed in detail in the swollen joint module), to the life-threatening (such as malignancy, sepsis or non-accidental injury).
Various conditions which may cause limp are discussed in this module.
Further information on the spectrum of causes of limp is available.
Careful clinical assessment will help you to determine the likely cause, help identify red flags in the history and red flags in the examination, and guide further investigations and management.
We encourage you to watch this short video which shows a 22 month old girl limping. Whilst watching the video, ask yourself the following; Do you think she is in pain? Look out for verbal and non-verbal clues. Which joints are affected? Look at both her upper and lower limbs.
Key points to note are:
- The child may not give any verbal history and observation of limp may be by the parent / carer.
- The history may not tell you where the problems are (so you need to examine all joints as part of your general assessment - at least perform a pGALS assessment).
- Children may not verbalise pain and non-verbal clues are important (e.g facial expression, withdrawal of a limb or non-use of a limb).
- Normal musculoskeletal development is important to know as there are different normal ranges of joint movement, differences in leg alignment at different ages and motor milestones change with age. So you need to know what is normal to be able to identify what is abnormal.
- Growing pains do NOT cause limp. Be aware of the rules of growing pains
The photograph shows a swollen ankle (left) with tenosynovitis. This child presented with a limp.