Children may occasionally limp when they have a leg injury, but prolonged limping without any physical injury could cause concern. The cause of limping could range from a simple injury to an underlying medical condition. If there is pain associated with limping, it should not be considered a growing pain, as growing pains never cause limping.
It is best to consult your healthcare provider if your child starts limping for no apparent reason. If the limping is due to a physical injury, it can be treated with rest, ice, or physical therapy in most cases.
Keep reading as we tell you all you need to know about limping in children, including its symptoms, causes, diagnosis, and treatment.
Symptoms Of Limping In A Child
While limping itself is a symptom of an injury or medical condition, it could be difficult to determine it in young children. Here are some symptoms that can accompany the limping.
- Weakness or numbness in the legs or feet
- Pain in the hips
- Frequent falls
- Inability to sit for too long
- Complaints of pain in the back of the legs
- Inability to move the toes
- A lack of balance while walking
Once you have identified the symptoms, next, you need to understand why your child is limping.
Causes Of Limping In Children
The causes of limping in children may range from a simple physical injury to an underlying medical condition. Let us look at each one in detail.
1. Physical injury
This is a common cause of limping in children. If your child experienced physical trauma while playing and has started to limp, it could be due to gait deviations or a fracture or sprain in the hips, ankle, or legs. Your doctor will likely ask you the following questions to confirm if the limping is due to a fracture (1).
- Did the child get up immediately after falling?
- When did the limping start?
- Does your child feel comfortable while crawling?
- Did you see any external injuries?
2. Irritable hip
Also known as transient synovitis, irritable hip is a common condition that causes hip pain and limping in children. It generally occurs due to the inflammation of the lining that covers the hip joint. The symptoms include pain and limited motion of the hip, and the condition is self-limiting (2).
Infections of the bone can also cause limping in children. One such infection is septic arthritis. The symptoms of septic arthritis are similar to that of irritable hip, so these two are often confused. Septic arthritis is characterized by a bacterial infection of the synovial joint and joint tissues. It mostly affects the hip and knee joints but could also affect the shoulder and ankle joints. Studies suggest that septic arthritis is mainly seen in children under the age of four.
Along with the limping, a child with septic arthritis would also have a fever, joint pain, joint swelling, reluctance to walk on the affected limb, warmth around the affected joint, loss of appetite, and episodes of vomiting (3). Another type of bone infection caused by bacteria is osteomyelitis, which is characterized by inflammation of bone. The condition can also cause limping in children (4).
4. Juvenile arthritis
This is a condition found in children under 16 years. It is commonly characterized by the swelling of the joints and lymph nodes for up to six weeks. Although the exact cause is not known, the autoimmune disease is believed to be triggered by a combination of genetic factors, environmental factors, and a weak immune system.
Legg-Calve-Perthes (LCP) is a rare condition found in children aged five to seven years. It is characterized by painful limping and limited range of motion of the hip. It affects the femoral head, and the pain is often felt during physical activity. In some children, the pain might radiate into the thigh and knee (6).
LCP occurs when the blood supply to the femoral head is temporarily disrupted. The revascularization(restoration of blood flow) may occur over two to four years if the child is under 12 years old at the onset of the disease (7).
6. Slipped capital femoral epiphysis (SCFE)
This is a condition that affects the hips of a child. In SCFE, the thigh bone ball slips off the thigh bone’s neck. Children might get this condition after a sudden fall or an injury.
It is characterized by limping, pain that gets worse with activity, pain in the thigh, knee, and groins, and an outward-turned leg when they walk (8).
Other medical conditions that can result in limping are
- Scoliosis, which is characterized by an abnormal curvature of the spine. This may cause the body to lean to one side, causing the child to limp.
- Congenital disabilities of the hip, such as dislocated dysplasia of the hip. These can occur before birth or develop later.
- Cerebral palsy. It is a condition that affects the nerves, causing the child to limp (2).
Diagnosis Of The Reasons For Limping
Based on the additional symptoms, your doctor might order the following tests to understand the reason behind the limping.
Physical examination, X-rays, and ultrasounds may help determine if there is a fracture or a sprain in the legs that might be causing the limping.
Two helpful tests that might help your doctor determine the cause behind the limping include (1)
- Simulated prone internal rotation of the hip. In this test, the child is held chest-to-chest by the parent, and the hips are extended fully. This position gives an accurate measure of the hip’s internal rotation and can help determine synovitis, arthritis, and Perthes disease.
- Crawl test. If the child is limping but can crawl, the problem is limited to the leg and feet. Thus, pelvis osteomyelitis and hip and knee sepsis can be ruled out. However, if they find trouble crawling, it could likely be tibia fracture, foot fracture, or osteochondritis.
Treatment For Limping In Children
Your doctor is the best person to evaluate the condition and suggest the best course of action.
If it is a minor injury or an ankle sprain, the doctor might suggest restricting the movement, cold compression, and elevating the injured leg. In the case of slipped upper femoral epiphysis, the child may need surgery as soon as possible. Your doctor may prescribe crutches to reduce the weight on the injured leg.
Your doctor may also prescribe antibiotics for the treatment of infections. You can prevent certain causes such as injury and sprains by instructing your child to do regular stretching exercises before playing. You can also give them a nutritious diet so that their bones grow strong and healthy.
Limping is common in children, but it could be a symptom of an underlying medical condition in some cases. It is best to evaluate the condition and understand the reason behind it. A healthy pair of legs is crucial for children, as this is the age when they love to jump, run, and play around.
2. Limping In Children; National Health Service (UK)
3. Septic Arthritis; St. Louis Children’s Hospital
4. Sindhur P.K et al.; Study of Osteomyelitis in pediatric patient; J PediatrRes (2017).
5. Juvenile Arthritis; Symptoms & Causes; Boston Children’s Hospital
6. Vito Pavone et al.; Aetiology of Legg-Calvé-Perthes disease: A systematic review; World Journal of Orthopedics (2019).
7. Benjamin Joseph; Management of Perthes’ disease; Indian Journal of Orthopaedics (2015).
8. Slipped Capital Femoral Epiphysis in Children; University of Rochester Medical Center
9. Y.Lefevre et al.; Pediatric leukemia revealed by a limping episode: A report of four cases; Orthopaedics & Traumatology: Surgery and Research (2009).
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