Assessment and management of the non-traumatic limp in children: a review

A limping child is a common presentation to the emergency department and onward referral to the trauma and orthopaedic services in the UK, with an incidence of 1.8 per 1,000 of emergency department presentations. The differential diagnosis is broad, encompassing congenital, developmental, infectious, inflammatory, traumatic, and neoplastic aetiologies. While many causes of limp are benign and self-limiting, certain conditions require urgent intervention to prevent catastrophic outcomes. A systematic approach, incorporating a detailed history, thorough physical examination, and judicious use of laboratory and imaging studies, is essential for accurate diagnosis. Management strategies vary considerably depending on the underlying aetiology, ranging from conservative observation and physiotherapy to urgent surgical intervention. This review provides a comprehensive overview of the assessment and management of some of the most common and serious causes of the paediatric limp, with emphasis on evidence-based diagnostic approaches and treatment modalities. Early recognition and appropriate management are crucial to optimize outcomes and ultimately prevent complications and long-term morbidity.