Limping Child

Definition

  • Any change from the normal gait pattern for age, with or without pain

Differential Diagnosis

AgeCauses
1 to 3 yearsToddler fracture, septic arthritis, DDH, non-accidental injury, cerebral palsy
4 to 10 yearsTransient synovitis, Perthes disease, septic arthritis, discitis, juvenile idiopathic arthritis
11 to 16 yearsSUFE, osteochondritis dissecans, overuse and apophysitis, tumour
  • Leukaemia and neuroblastoma can present with limp and bone pain at any age

Clinical Features

  • Antalgic gait shortens stance phase on the painful side
  • Trendelenburg gait points to hip abductor weakness or hip instability
  • Hip pathology often presents with knee pain
  • Examine the spine, abdomen, hips, knees and feet
  • Red flags are fever, night pain, refusal to bear weight, weight loss and unexplained bruising

Investigations

Transient Synovitis of the Hip, ultrasound showing a hip joint effusion in transient synovitis
Ultrasound showing a hip joint effusion in transient synovitis. Image by Article authors: Ruiz Santiago, Fernando; Santiago Chinchilla, Alicia; Ansari, Afshin; Guzmán Álvarez, Luis; Castellano García, Maria del Mar; Martínez Martínez, Alberto; Tercedor Sánchez, Juan, Wikimedia Commons, CC BY 4.0.
  • FBC, CRP, ESR and blood cultures when infection is possible
  • X-ray of the symptomatic region, with AP and frog leg lateral pelvis for hip symptoms
  • Ultrasound to detect a hip effusion and guide aspiration
  • MRI when the cause remains unclear
  • Ultrasound for hip effusion
  • MRI when examination localises the problem but radiographs are normal
  • Kocher criteria help separate septic arthritis from transient synovitis

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.