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Limping is a common chief complaint among children that prompts parents to seek medical attention.  Because of different anatomy, the acute onset of a limp may be a diagnostic challenge in pediatric population. The anatomy and physiology of a child's musculoskeletal system is quite different than an adult, requiring the practitioner to acknowledge specific etiologies that are prevalent within this population.(1) In one study over a 3-month period, nearly 5% of patients seen in emergency department visits presented for evaluation because of inability to bear weight or because of a limp.(2) A normal mature gait cycle consists of the stance phase, during which the foot is in contact with the ground, and the swing phase, during which the foot is in the air. The stance phase is further divided into three major periods: the initial double-limb support, followed by the single-limb stance, then another period of double-limb support.(3) The gait undergoes orderly stages of development. A mature gait pattern is well established by three years of age, and the gait of a seven-year-old child closely approximates that of an adult.(4)  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.(2, 5) A detailed history and physical examination, in addition to appropriate laboratory tests and imaging, are essential for making a correct diagnosis.(5) In this review we take the reader through the normal development of gait, then discuss normal variants of gait in order to identify pathological gait patterns.

Keywords: limping, gait, pediatric

     

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