Current concepts review on the limping child

Diagnosing the cause of an atraumatic limp in children is challenging, as conditions with overlapping clinical presentations can range from self-limited processes to orthopedic emergencies. Knowledge of evolving risk factors, diagnostic practices, and management approaches is crucial to efficient treatment. This review synthesizes recent evidence on the evaluation of the limping child, focusing on key diagnoses including transient synovitis of the hip (TSH), septic arthritis of the hip (SAH), slipped capital femoral epiphysis (SCFE), and Legg-Calvé-Perthes disease (LCPD).

For SAH and TSH, emerging evidence supports point-of-care ultrasound alongside clinical findings and inflammatory markers to improve diagnostic differentiation. In SCFE, increasing incidence, recognition of additional risk factors, variable pain presentations, and evolving approaches to surgical timing and contralateral risk have implications for diagnosis and management. For LCPD, current studies highlight variability in pain presentation, advances in radiographic classification, and individualized operative containment strategies.

This review provides a synopsis of recent literature surrounding SAH, TSH, SCFE, and LCPD. Recent advances may facilitate earlier recognition, improve risk stratification, and support more individualized management for children presenting with a new limp. While this article highlights four important diagnoses, clinicians should maintain a broad differential of classic and atypical presentations of limping.