Sudden or persistent limping is one of the common reasons why parents seek orthopedic evaluation for their children.
When evaluating limping in a child, we first examine the possibility of an underlying injury (trauma, fracture, or soft tissue injury). Identifying injuries in children is not always straightforward, especially if the child is too young to communicate effectively. If a fracture or similar issue is detected, immobilization is usually recommended for several weeks to allow the tissue to heal. Treatment is carried out in the emergency department and continues in the pediatric orthopedic clinic.
When an injury is ruled out as a cause of limping, we then explore the possibility of an infectious process (in the joint, bone, or soft tissues). This is a highly dangerous condition due to the increased risk of local tissue damage and the spread of bacteria to other tissues through the bloodstream. The evaluation includes discussions with the child and parents, physical examination, blood tests, and imaging. If there is a significant concern for infection, the next step involves obtaining fluid from the suspicious tissue for bacterial culture. Antibiotic treatment will be initiated concurrently. The choice of medication initially relies on familiarity with the typical bacteria associated with different types of infections. The treatment plan will be updated based on cultural findings. The decision of whether to administer treatment intravenously or orally depends on the child's condition at the start of treatment, and the duration of treatment depends on the healing process. In some cases, surgical intervention may be necessary to drain the infected tissue and remove debris. The follow-up will be carried out within the framework of the infectious disease clinic or a pediatric day hospital, in parallel with the orthopedic follow-up.
A common cause of "sudden" limping, which is not related to injury (trauma) or caused by infection, is reactive synovitis (synovial inflammation). This condition occurs after an infection in another part of the body (e.g., flu or gastrointestinal infections). It is characterized by pain in one joint (usually the hip joint) and typically appears a few days after the infection. This condition usually resolves within a few days, and the child is usually given pain-relieving medications such as Neurufen, Advil, or similar.
Another cause of limping in children between the ages of 4 and 9 is Legg-Calvé-Parthes syndrome, where a disturbance in blood flow to the femoral head (the ball-like structure inside the hip joint) leads to changes in its shape, potentially affecting the hip joint's movement. Currently, there is no agreed-upon treatment for this condition. Children under the age of 6 usually recover from this process with very little damage to the femoral head (due to their significant growth potential). However, children older than 6 may experience less favorable outcomes. When suspicion arises that limping is caused by this phenomenon, the child will be invited for a follow-up in the pediatric orthopedic clinic. The treatment plan will be based on the child's age and the severity of the femoral head damage.
During adolescence, we encounter a unique phenomenon called slipped capital femoral epiphysis (SCFE). This condition also affects the ball of the femoral head. In adolescence, there is a weak area at the base of the ball, which can occasionally slip out of place, resulting in the ball being positioned abnormally relative to the femur. This condition only occurs in adolescents and requires surgical stabilization. Without treatment, severe damage to the hip joint can occur (to the extent that sometimes the opposite side is also operated on as a preventive measure).
Of course, there are many other reasons for limping in children, and this summary covers only a limited number of common conditions. The information provided here is preliminary and not a substitute for a personal medical examination and treatment plan. Additional information about the described conditions and other phenomena can be found on the internet. We would be happy to provide further explanations and discuss the investigation and treatment process when attending to your children.
For any questions, please feel free to email Dr. Ehood Lebel at lebel@szmc.org.il.