Among the causes of gait abnormality in childhood, those that
should be kept in mind in acute settings include infection, trauma,
and malignancy. Children who develop a limp acutely should be evaluated
carefully with a detailed history and physical examination, appropriate
radiographs and laboratory studies, and timely referral for subspecialty
evaluation in order to exclude these potentially worrisome causes.
When necessary, the lower extremity should be carefully immobilized
and protected from weight bearing until a definitive diagnosis can
be achieved. When infection is suspected, the workup should be conducted
in either an observation or inpatient status until the diagnosis
is confirmed or excluded. This ensures that appropriate diagnostic
and therapeutic resources can be brought to bear in a timely manner
before the infection worsens without a correct diagnosis. Regardless
of the underlying cause of the limp, vigilance is necessary in order
to make an accurate diagnosis in a timely manner to ensure the best
outcome.