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Chapter 53: The Child With a Painless Limp

Hugh G. Watts

Description of the Symptom

A limp can be defined as any deviation, commonly asymmetric, from a normal gait pattern, and may be caused centrally, as a result of cerebral dysfunction, or peripherally, due to weakness or pain in the trunk or lower extremities. This chapter describes possible causes of a limp in a child.

Special Concerns

  • Suspicion of child abuse

  • Associated with fever

CHAPTER PREVIEW: Conditions That May Lead to a Painless Limp in a Child
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CHAPTER PREVIEW: Conditions That May Lead to a Painless Limp in a Child
T  Trauma
COMMON
Slipped femoral capital epiphyses 1051
UNCOMMON

Child abuse 1042

Chondral injury of the hip 1042

Tear of the acetabular labrum 1052

Toddler's fracture of the tibia 1052
RARE
Not applicable
I  Inflammation
COMMON
Not applicable
UNCOMMON

Aseptic

Juvenile rheumatoid arthritis 1045

Juvenile rheumatoid arthritis-like diseases:

  • Arthritis associated with inflammatory bowel disease 1046

  • Dermatomyositis 1046

  • Juvenile ankylosing spondylitis 1046

  • Scleroderma 1047

Septic

Not applicable
RARE

Aseptic

Ataxia telangiectasia 1042

Demyelinating polyradiculoneuropathies:

• Acute demyelinating polyradiculoneuropathy (Guillain-Barré syndrome) 1043

• Chronic demyelinating polyradiculoneuropathy 1043

Juvenile rheumatoid arthritis-like diseases:

• Polymyositis 1047

• Reactive arthritis (Reiter's syndrome) 1047

• Systemic lupus erythematosus 1047

Septic

Poliomyelitis 1050
Me  Metabolic
COMMON
Not applicable
UNCOMMON
Not applicable
RARE

Ehlers-Danlos syndrome 1045

Lesch-Nyhan syndrome 1048
Va  Vascular
COMMON
Osteochondritis dissecans of the knee 1050
UNCOMMON
Legg-Calvé-Perthes disease 1048
RARE
Not applicable
De  Degenerative
COMMON
Not applicable
UNCOMMON
Not applicable
RARE

Chondrolysis 1043

Friedreich's ataxia 1045

Muscular dystrophies:

• Becker muscular dystrophy 1049

• Duchenne muscular dystrophy 1049

Spinal muscular atrophies:

• Kugelberg-Welander disease (juvenile, type III) 1051
Tu  Tumor
COMMON
Not applicable
UNCOMMON

Malignant Primary:

Not applicable

Malignant Metastatic:

Not applicable

Benign, such as:

  Syringomyelia 1054
RARE

Malignant Primary, such as:

  Leukemia 1053

Malignant Metastatic:

Not applicable

Benign, such as:

  • Bone cysts of the lower extremity:

    • Aneurysmal 1052

    • Unicameral 1052

  • Eosinophilic granuloma (Langerhans' cell histiocytosis) 1053

  • Fibrous dysplasia 1053

  • Osteochondroma 1053

  • Trevor's disease (dysplasia epiphysealis hemimelica) 1054
Co  Congenital
COMMON

Leg-length discrepancy 1047

Myelodysplasia 1049
UNCOMMON

Arthrogryposis:

• Amyoplasia (arthrogryposis multiplex congenita) 1041

• Distal arthrogryposis 1041

Limb deficiencies:

• Congenital deficiency of the tibia 1048

• Congenital short femur 1048

Myopathies, congenital 1049
RARE

Coxa vara, congenital 1043

Developmental dysplasia of the hip with dislocation 1043

Discoid lateral meniscus 1044

Dislocated patella, congenital 1044

Dysplasias of bone and cartilage:

  • Epiphyseal dysplasia 1044

  • Metabolic chondrodysplasia 1044

  • Morquio's syndrome 1044

  • Spondyloepiphyseal dysplasia 1044

Larsen's syndrome 1047
Ne  Neurogenic/Psychogenic
COMMON

Cerebral palsy 1042

Encephalopathy (postencephalitis, postmeningitis, post-traumatic) 1045

Post-central nervous system vascular insufficiency or hemorrhage 1051
UNCOMMON

Spinal dysraphisms:

  • Diastematomyelia 1051

  • Tethered cord syndrome 1051
RARE

Malingering 1048

Myotonia congenita 1050

Peripheral neuropathies:

  • Hereditary motor and sensory neuropathies Types I and II (Charcot-Marie-Tooth disease) 1050

  • Hereditary motor and sensory neuropathy Type III (Dejerine-Sottas disease) 1050

Note: These are estimates of relative incidence because few data are available for the ...

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