This website uses cookies to give you the best experience. By continuing to use this website you are consenting to cookies being used. You can delete and block cookies from within your browsers settings. For more information please refer to our privacy and cookie policy page.


Intermittent Limp 1

A 5 year old boy presents to the Emergency department with a 5 day history of intermittent limp. His parents are concerned as he is crying when he walks. He has previously been happy to walk and had started to walk aged 15 months. He was otherwise well with no systemic complaints. 

On examination he looked well, was afebrile but was limping. General examination was unremarkable, his abdomen was soft and non-tender and his testes appeared normal. He was reluctant to weight bear but hip movements appeared pain free and with normal range of movement. Other joints appeared normal. 

Hip radiographs were reported as normal. Hip ultrasound showed no effusion. Blood tests (full [complete] blood count, acute phase reactants) were normal. 

No apparent cause for his limp was found but he continued to have an intermittent limp. He was referred to paediatric rheumatology. The history was probed further and it was apparent that he had pain worse on weight bearing. Examination of his feet showed a large plantar wart on the sole of his foot - this was very tender. 

The diagnosis was a plantar wart on his foot!

This case highlights the importance of careful clinical examination as the most crucial aspect of the evaluation; checking soles of the feet for easily missed problems and easily treatable benign problems is important. Plantar warts, ingrown toe nails, splinters / foreign bodies and even ill-fitting shoes are frequent causes of limp and should be considered before escalating investigations (and especially if they are invasive, involve radiation or require sedation).

The photograph below shows the soles of the feet and surface anatomy. 


Site Statistics

To date (end of August 2021) PMM has >910,640 hits and >376,455 users from 221 countries!

Why register?

Some parts of PMM which involve pictures or videos of children, can only be viewed by registered users. Registering also allows you to bookmark favourite pages and track your viewing.

find out more

Short online courses

from Newcastle University, UK

e-resources from PMM

pmm for you

Please help us ensure pmm is as useful to you as possible by completing this short survey

complete survey