UMEM Educational Pearls

Category: Pediatrics

Title: Child with a Limp

Keywords: Limp, Antalgic Gait, Trendelenburg Gait, Septic Arthritis, Legg-Calve-Perthes Disease, SCFE (PubMed Search)

Posted: 12/21/2007 by Sean Fox, MD (Updated: 10/18/2019)
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Child with a Limp

  • First classify the limp:
    • Antalgic gait = shortened stance phase of the affected extremity due to PAIN
    • Trendeleburg gait = equal stance phase between involved and uninvolved side, shifted center of gravity; NOT Painful
  • Etiologies
    • Painful Limp
      • 1-3 years of age: Septic Joint, Occult Trauma, Neoplasm
      • 4-10 years of age: Septic Joint, Transient Synovitis, Legg-Calve-Perthes Disease, Trauma, neoplasm, Rheumatologic D/O
      • 11 + years of age: SCFE, Rheumatologic D/O, Trauma, (consider AVN in pts with sickle cell disease)
    • Trendelenburg Gait
      • Indicative of underlying hip instability or muscle weakness
      • Think of congential hip dislocation and Neuromuscular Diseases/Disorders

Grossman, Emblad, Plantz. Orthopedic Emergencies in Pediatric Emergency Medicine Board Review.  2nd Edition. 2006. p305.