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The Causes of Limp

Limp can be broadly divided into acute and chronic and broadly categorised by age.

Red flags suggest conditions not to be missed.

The Table below is a helpful reminder but is not a comprehensive list of all causes

Remember to consider important other causes

  • testicular torsion / epididymo-orchitis 
  • appendicitis / psoas abscess 
  • inguinal hernia

Age

Acute limp

with non-weight bearing likely

Chronic and insidious limp –

pain may be less obvious as a presenting feature

1–3 years

Septic arthritis/osteomyelitis (Red Flag)

Transient synovitis

Trauma / Non-accidental injury (Red Flag)

Developmental dysplasia of hip

Neuromuscular disorder (e.g. cerebral palsy)

Muscular dystrophy

Unequal leg length (e.g. post physeal injury or untreated inflammatory arthritis)

Inflammatory joint and muscle disease 

3–10 years

Transient synovitis

Septic arthritis/osteomyelitis (Red Flag)

Trauma

Perthes disease (acute)

Malignant disease eg, leukaemia (Red Flag)

Inflammatory joint and muscle disease

Perthes disease

Developmental dysplasia of hip

Neuromuscular disorders, eg Duchenne muscular dystrophy

Inflammatory joint and muscle disease

11–16 years

Slipped upper [Capital] femoral epiphysis (acute)

Avascular necrosis of the femoral head

Inflammatory joint and muscle disease

Trauma

Septic arthritis/osteomyelitis (Red Flag)

Bone tumours (Red Flag)

Slipped upper [Capital] femoral epiphysis

Inflammatory joint and muscle disease

Dysplastic hip

Chronic or intermittent limp can be more diagnostically challenging than acute limp. 

Consider the following which are covered under key conditions; 

  • Orthopaedic conditions, for example, Perthes’ disease, slipped capital femoral epiphyses
  • Rheumatological conditions, for example Juvenile Idiopathic Arthritis or Juvenile Dermatomyositis
  • Metabolic conditions, for example rickets
  • Neurological conditions, for example cerebral palsy, muscular dystrophy

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