The Child with a Painless Limp

  • James Robb


A limp in a child is a deviation from the gait pattern expected at the particular stage in the child’s development. Children start walking around 12–14 months of age and do not acquire an adult walking pattern until after the age of 4 years (Sutherland et al. 1980). Toddlers have a broad base of support, a faster cadence (steps per minute), and a slower velocity than an adult and do not have reciprocal arm movements. Their legs are externally rotated, knees remain flexed in stance, and heel strike does not usually occur until around 15–18 months of age when reciprocal arm movements begin to appear as well. Running and the ability to change direction smoothly occur after the age of 2 years, and by the age of three, the child’s base of support is approaching that of an adult, and most will have reciprocal arm movements. It is important that these immature patterns of gait are not misinterpreted as being abnormal.


Cerebral Palsy Gait Pattern Hereditary Spastic Paraplegia Limb Length Discrepancy Pelvic Obliquity 
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Supplementary material

Video 24.1

Stiff-knee gait in a boy with cerebral palsy; the compensatory circumduction is clearly seen (MPG 3902 kb)

Video 24.2

Hand-to-thigh gait in a boy with quadriceps paralysis following poliomyelitis (MPG 3567 kb)

Video 24.3

High-stepping gait in a boy with foot drop following paralysis of the anterior compartment muscles. The toe-heel sequence is noted on the paralyzed foot (MP4 1252 kb)

Video 24.4

Equinus gait in a child with hemiplegic cerebral palsy with contracture of the gastrocsoleus on the right (MP4 1565 kb)

Video 24.5

Bilateral equinus deformity in a child with a form of muscular dystrophy (AVI 17309 kb)

Video 24.6

Varus thrust in a child with unilateral Blount’s disease (AVI 19041 kb)

Video 24.7

Knee instability in a boy with Larsen syndrome (MP4 3281 kb)


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Copyright information

© Springer India 2015

Authors and Affiliations

  • James Robb
    • 1
  1. 1.OrthopaedicUniversity of St AndrewsScotlandUK

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