Limping in children

What is limping?

Limping is an abnormal walking pattern. The walking may be laboured or jerky. Limping may be caused by pain or weakness anywhere in the leg, especially the joints. Often a limp is caused by a minor injury. There may be a structural problem with the leg or joints. Other serious conditions can also cause limping.

Since children are growing, the bones and muscles they use for walking are still developing. Limping is never normal. Your child's doctor should look into any limping right away.

Signs and symptoms of limping

• walking irregularly
• hobbling
• pain or discomfort while walking
• putting less pressure on one foot

Other children avoid walking, even though they can walk.

Causes of limping

Limping has many causes. These include injuries, infections, inherited or developmental problems. Rheumatic disorders and cancer may also cause limping. Your child's doctor will check your child's age, size, the level of pain and when the limp started in order to determine the cause.

Injuries

• sprained or injured ligaments; a sprained ankle is very common
• muscle strains
• "toddler's fracture," a common injury from jumping and landing on a twisted ankle
• fractured bones

Different leg lengths or hip problems

Some children are born with uneven leg lengths. Other children injure a leg, resulting in a shorter length.

Uneven leg lengths can also occur as a result of untreated developmental dysplasia. This condition may leave one leg longer than the other.

Other hip and leg problems that can cause limping include:

• Legg-Calve-Perthes disease: the softening of the growing end of the femur (thigh bone).
• Slipped capital femoral epiphysis: when the head of the femur slips off the shaft. This is common in overweight teenagers.
• Transient synovitis: inflammation of the membrane that covers the hip joint.

Joint or bone infection

A limp can also be caused by infection in the joints or the bones. A joint infection is called septic arthritis. A bone infection is called osteomyelitis​. These infections are caused by bacteria spreading through the bloodstream from another part of the body.

With these types of infection, your child may refuse to walk at all. Your child may also have severe pain, fever or redness in the infected area.

Bone or joint infections are serious. If your child has symptoms of a bone or joint infection, see a doctor right away.

Arthritis

Juvenile idiopathic arthritis is a chronic condition that causes joint swelling. The swelling can cause pain in the knees. This can lead to a limp.

Cancer

Certain forms of cancer can cause limping. These include leukaemia, osteosarcoma and Ewing's sarcoma. Children with these types of cancer are usually less than five years old. They may look pasty and pale. They may complain of deep bone pain when resting.

Certain spinal problems can cause limping:

• Spondylolysis: a problem with the vertebrae (back bones) that occurs from injury. It may occur from repeatedly flexing or overextending the spine. Athletic children can develop this condition.
• Spondylolisthesis: when a vertebra slips forward.

Other problems that can cause limping include:

• muscle problems like muscular dystrophy
• appendicitis and other abdominal problems

What your child's doctor can do

Your child's doctor will do a physical examination to try to determine the cause of the limping. Depending on your child's other symptoms, the doctor may suggest blood work, X-rays or other tests.

Treatment

Treatment will depend on the cause of the limping. If your child has a sprained muscle or joint, try resting the foot or leg, and treating the injury with ice. Your doctor may suggest giving your child ibuprofen to manage the pain and inflammation. Support bandages or an air cast can reduce the swelling. They can also help prevent further injury to the ankle. Your child may use crutches if they find it hard to walk.

Limping caused by other conditions may require specific medications or other treatment. See your doctor for more information.

When to see a doctor

Go to the nearest Emergency Department if your child has a limp plus any of the following symptoms:

• fever
• rash
• poor appetite
• pale complexion
• severe pain

Return to see your child's doctor if:

• you notice significant swelling around particular joints