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Approach to the child with a limp

Section Editors
Gary R Fleisher, MD
Jan E Drutz, MD
William Phillips, MD
Deputy Editor
James F Wiley, II, MD, MPH


Limp is defined as an uneven, jerky, or laborious gait, usually caused by pain, weakness, or deformity [1]. It is a common complaint in childhood, accounting for 4 per 1000 visits in one pediatric emergency department [2]. Limp can be caused by both benign and life-threatening conditions (table 1); the management varies from reassurance to major surgery depending upon the cause [2,3].

The cause of limp usually can be determined by obtaining a careful history and physical examination. Radiographic studies often are necessary to confirm clinical suspicions, but diagnostic procedures rarely are required. Although most cases of limp are caused by trauma or benign self-limiting conditions, life- or limb-threatening conditions must be diagnosed promptly (table 2) [4,5].

The evaluation of the limping child is reviewed here. An overview of specific causes of limp in children is presented separately. (See "Overview of the causes of limp in children".)


In the emergency department or primary care practice, minor trauma predominates as the typical etiology for limp. Observational studies of children without a clear history of trauma who were evaluated in tertiary care centers or orthopedic clinics tend to emphasize serious infectious disease diagnoses such as osteomyelitis or septic arthritis [2,3,6,7]. One prospective study that evaluated 243 children younger than 14 years of age who presented to a pediatric emergency department with limp and no history of trauma had the following findings [4]:

Boys outnumbered girls by almost two to one.


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Literature review current through: Sep 2016. | This topic last updated: Aug 11, 2016.
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