[Some considerations on evaluation of the acutely limping child].

INTRODUCTION: An acute limp implies an underlying pathology that causes disruption of the standard gait pattern.

DIAGNOSIS AND HISTORY OF DISEASE: The differential diagnosis of a limp includes trauma, infection neoplasia, inflammatory, congenital, neuromuscular or developmental disorders. History of disease and clinical examination present first steps in adequate evaluation. A useful approach is to consider the causes of limping from head to foot to avoid overlooking common underlying conditions. The age of patient can further narrow the differential diagnosis, because certain disease entities are age-specific.

LABORATORY ANALYSIS: Laboratory analysis should always include complete blood count, erythrocyte sedimetation rate, C-reactive protein, rheumatic factor, PPD 3. In some cases we have to perform tests of enzyme values such as alkaline phosphatase, lactate dehydrogenase, and other subspecial analyses in order to exclude some systemic and autoimmune diseases.

RADIOLOGIC DIAGNOSIS: Radiologic diagnosis should include: ultrasonography (doppler ultrasonography and in some cases, arteriography); Plain films (always anteroposterior (AP) and profile or some special angle); computed tomography, magnetic resonance imaging.

CONCLUSION: In this paper we suggested an algorithm for examination of a limping child: 1. Analysis of foot morphology and the gait without socks and shoes. 2. Strength test including walking on toes and heels and running. 3. Evaluation of arthritis, stiffness, pain, skin changes. 4. Points of a maximum pain with ROM testing. 5. Traces of trauma with echimosis. 6. Evaluation of leg length discrepancy. 7. Muscle tonus. 8. Abdominal examination 9. Examination of the spine and back.