Deviations from a normal age-appropriate gait pattern can be caused by a wide variety of conditions. In most children, limping is caused by a mild, self-limiting event, such as a contusion, strain, or sprain. In some cases, however, a limp can be a sign of a serious or even life-threatening condition. Delays in diagnosis and treatment can result in significant morbidity and mortality. Examination of a limping child should begin with a thorough history, focusing on the presence of pain, any history of trauma, and any associated systemic symptoms. The presence of fever, night sweats, weight loss, and anorexia suggests the possibility of infection, inflammation, or malignancy. Physical examination should focus on identifying the type of limp and localizing the site of pathology by direct palpation and by examining the range of motion of individual joints. Localized tenderness may indicate contusions, fractures, osteomyelitis, or malignancy. A palpable mass raises the concern of malignancy. The child should be carefully examined because nonmusculoskeletal conditions can cause limping. Based on the most probable diagnoses suggested by the history and physical examination, the appropriate use of laboratory tests and imaging studies can help confirm the diagnosis
Figure 3.
Internal rotation of the hip is measured by placing the child in the prone position with knees flexed 90 degrees and rotating the feet outward. Loss of internal rotation is a sensitive indicator of intraarticular hip pathology and is common in children with Legg disease and slipped capital femoral epiphysis.
Figure 4.
Hip abduction is measured by placing the child in the supine position with hips and knees flexed and the toes placed together. To measure abduction, both knees are allowed to fall outward. Limited hip abduction, as in this child’s left hip, occurs in children with developmental dysplasia of the hip.
Reprinted with permission from Storer SK, Skaggs DL. Developmental dysplasia of the hip. Am Fam Physician. 2006;74(8):1313.
Figure 5.
Positive Galeazzi sign. The child is placed in the supine position with the hips and knees flexed. In a positive test, the knee on the affected side is lower than the normal side. This can occur in patients with any condition that causes a leg-length discrepancy, such as developmental dysplasia of the hip, Legg disease, or femoral shortening
