The Causes of Limp
Limp can be broadly divided into acute and chronic and broadly categorised by age. The Table below is a helpful reminder but is not a comprehensive list of all causes. The conditions in bold are potentially life threatening and not to be missed; many of these are covered under key conditions;
- Infectious or reactive conditions: e.g., septic arthritis, osteomyelitis, rheumatic fever.
- Malignancy: e.g., leukaemia.
- Orthopaedic conditions: e.g., Legg-Calves-Perthes’ disease, Slipped upper capital Femoral epiphysis.
- Rheumatological conditions: e.g., Juvenile Idiopathic Arthritis or Juvenile Dermatomyositis.
- Metabolic conditions: e.g., Rickets.
- Neurological conditions: e.g., cerebral palsy, muscular dystrophy.
Remember to consider causes that are not directly joint or muscle related (e.g., testicular torsion / epididymo-orchitis, appendicitis / psoas abscess, inguinal hernia, urine infection).
Chronic or intermittent limp can be more diagnostically challenging than acute limp.
|
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.
Rheumatic fever.
Transient synovitis.
Trauma / Non-accidental injury.
|
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.
Rheumatic Fever.
Trauma.
Perthes disease (acute).
Malignant disease e.g., leukaemia.
Inflammatory joint and muscle disease.
|
Perthes disease.
Developmental dysplasia of hip.
Neuromuscular disorders, e.g., 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.
Rheumatic Fever.
Bone tumours.
|
Slipped upper [Capital] femoral epiphysis.
Inflammatory joint and muscle disease.
Dysplastic hip.
|