What Is Causing a 5-Year-Old Boy’s Limp?

Authors:
Laura R. Meidl
University of Missouri - Kansas City School of Medicine in Kansas City, Missouri.

Natalie C. Stork, MD
University of Missouri - Kansas City School of Medicine and Children’s Mercy Kansas City in Kansas City, Missouri.

Julia G. Harris, MD
University of Missouri - Kansas City School of Medicine and Children’s Mercy Kansas City in Kansas City, Missouri.

Citation: Meidl LR, Stork NC, Harris JG. What is causing a 5-year-old boy's limp? Consultant for Pediatricians. 2017;e10.

An otherwise healthy 5-year-old boy presented to the pediatric rheumatology clinic for evaluation of a limp of 1 year’s duration. The patient also experienced intermittent right foot and ankle pain and transient morning stiffness lasting 60 minutes. His pain was worse with exercise, but this did not limit his activity. There was no history of trauma, and a complete review of systems was negative except for intermittent abdominal pain.

On physical examination, the boy was well appearing, and his vital signs were within normal limits. Musculoskeletal examination revealed no swelling, tenderness, erythema, warmth, pain with movement, or limited range of motion in any joints. The boy’s strength was normal and symmetric, and no tenderness was elicited with palpation of the lower extremities. He had an antalgic gait and had difficulty hopping on the right leg relative to the left, but he denied pain. Gowers sign was negative, and the rest of his examination was unremarkable.

Laboratory studies were obtained to evaluate for a chronic inflammatory process, infection, or muscular etiology and were within normal limits. A radiograph of the right foot (Figure 1) provided evidence that supported the diagnosis.

What is the cause of this boy's limp? (Answer on next page.)