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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.

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