A mother brings her 2 year old child in for a limp. The student believes the patient has ankle pain because she cried when she grabbed the ankle. After that she cried with everything. After calming the child down you watch her walk and it is abnormal but you wonder how to interpret this.


The last time I tried really hard to analyze gait and make recommendations, it was so complicated that no one could remember it. I now have a more simple approach. An abnormal gait is either neurologic or orthopedic. If there is pain, it tends to be orthopedic. No pain suggests neurologic.


Next, don’t just watch the gait. Imitate it. Follow the child. This allows your proprioceptive neurons to do the thinking for you.


When you do that on this child you see she is splinting her hip. You examine the calmed child and get good range of motion of the ankle and knee. Internal and external rotation of the hip seems to cause discomfort. Now your differential is transient synovitis vs septic arthritis and you proceed from there.


Take Home Points:

Painful gait abnormalities are usually orthopedic. Painless are usually neurologic.

Walk the walk: imitate the gait so you can feel what they are doing with their gait