Limping Grand daughter.
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Limping Grand daughter.
A friend of mine, caught up in the National Health in England, has a three year old grand daughter who has suddenly developed a pronounced limp.
This cause her no pain and her GP say: 'She's putting it on.'
So far, no surprise, no blood tests or X rays have been taken. No known family history to account for it, no known MS, for example.
I have come across this before, the pantom limp, and it has stayed with that particular girl for her life with no great problems.
However, any suggestions or clues as to where to direct the jolly old NHS would be appreciated.
Many thanks, have done trawl through previous posts on this forum.
cc.
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there are lots of causes of limping in children. Some can be serious. Should never be put down to "putting it on" until the appropriate investigations have been done, even if it is painless. If the GP won't investigate it properly, find one who will...(that is if you are 'allowed' to see a different GP under NHS rules 
)
)
Red On, Green On
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If money is not too big a problem I'd suggest an appointment/second opinion with/from a private paediatric orthopaedic specialist. The GP should be able to refer. Cost should be under £100, which may be cheap compared to the concern and worry of the family.
Most unlikely to be MS, for what it's worth. The vast majority of diagnoses are made in adults aged 25 ish and above. My wife was diagnosed with MS at 27.
Most unlikely to be MS, for what it's worth. The vast majority of diagnoses are made in adults aged 25 ish and above. My wife was diagnosed with MS at 27.
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don't worry - it definitely ain't MS!!! If there is a problem, it will be specific to the hip, eg Perthes (a bit young), transient synovitis (irritable hip - more likely), or a few other paediatric hip afflictions. Still need to get it sorted though
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My neice has irritable hip (I thought it bulls*** when I first heard the name). All tests blood and scans came back ok. My sister took her to an Osteopath who said one theory for Irritable Hip is the baby was ever so slightly twisted in the womb and when the child has a growth spurt this is when it happens and this is when the Osteopath manipulates her. She is 2 y.o at the moment.
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I am sorry if this sounds simplistic, but you may as well rule out the simple things first.
Yous said that this has happened recently. Has she by any chance had some new shoes bought recently?
If children's shoes do not fit properly both in length and width, or have something in then such as a stone or lump or nail (if they still use them), or a buckle or strap that rubs, then somethimg as simple as that can cause a limp.
At age 3 she may not be able to tell you.
Yous said that this has happened recently. Has she by any chance had some new shoes bought recently?
If children's shoes do not fit properly both in length and width, or have something in then such as a stone or lump or nail (if they still use them), or a buckle or strap that rubs, then somethimg as simple as that can cause a limp.
At age 3 she may not be able to tell you.
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Thread Starter
That's a sensible and hopeful thought. I will pass it on. Thank you all for the input so far; please keep it coming.
Regards.cc
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As Belfast Child mentions it could be Perthes - although 3 is young that is the age when my son was diagnosed with it. If it is that then young is good as they seem more likely to recover without intervention.
Perthes is where the ball at the top of the thigh bone that fits into the hip bone crumbles - sounds frightening at first, but the bone slowly grows back, and the child is monitored with x-rays to ensure that the new bone is developing with the correct shape. Diagnosis is also easy because an x-ray of the hip shows it clearly.
My son is now 6, and since it was diagnosed he has had no further problems - his gait is slightly funny when he runs, but nothing much. The consultant he sees every year believes that there is no reason to think that this episode will make him any more susceptible to arthritis in the joint when he is older. I suspect that if he had the genes to be a top athlete it could prove a hinderance, but he takes after me in that respect, so not a concern for us!
Apparently Perthes is most prevalent in the North of England among low income and under nourished children, although we only ticked the first box.
Hope it proves to be something trivial - best of luck.
Perthes is where the ball at the top of the thigh bone that fits into the hip bone crumbles - sounds frightening at first, but the bone slowly grows back, and the child is monitored with x-rays to ensure that the new bone is developing with the correct shape. Diagnosis is also easy because an x-ray of the hip shows it clearly.
My son is now 6, and since it was diagnosed he has had no further problems - his gait is slightly funny when he runs, but nothing much. The consultant he sees every year believes that there is no reason to think that this episode will make him any more susceptible to arthritis in the joint when he is older. I suspect that if he had the genes to be a top athlete it could prove a hinderance, but he takes after me in that respect, so not a concern for us!
Apparently Perthes is most prevalent in the North of England among low income and under nourished children, although we only ticked the first box.
Hope it proves to be something trivial - best of luck.
Plastic PPRuNer
This sort of story always makes my alarm lights flicker. Limping without a firm history of injury in a child usually means significant pathology.
It could be lots of things, some trivial and some not at all trivial.
"...her GP say: 'She's putting it on.'" - I don't buy that at all except for an hour maybe - kids of that age don't have the ability for sustained deception (or the need, either).
Suggest your friend gets an appointment with a pediatric surgeon or orthopod soonish.
It could be lots of things, some trivial and some not at all trivial.
"...her GP say: 'She's putting it on.'" - I don't buy that at all except for an hour maybe - kids of that age don't have the ability for sustained deception (or the need, either).
Suggest your friend gets an appointment with a pediatric surgeon or orthopod soonish.
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Interesting and all sorts of possibilities (foot, ankle, leg, knee, thigh, hip, spine) as to cause.
Seat1APlease makes a good point but if she limps barefoot then it is unlikely to be a shoe problem.
In a nutshell it appears to be a movement problem.
Solution. See a movement specialist i.e. a good physiotherapist.
Cheaper than a orthopod and more likely to offer a practical approach.
Seat1APlease makes a good point but if she limps barefoot then it is unlikely to be a shoe problem.
In a nutshell it appears to be a movement problem.
Solution. See a movement specialist i.e. a good physiotherapist.
Cheaper than a orthopod and more likely to offer a practical approach.
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Thread Starter
Thank you again gentlemen. I was rather hoping that some who have answered would have done so. The information has been most gratefully received by the worried grandfather.
I am reliably informed that the little girl in question now has an overwhelming urge to become a pilot. There will be some out there who may have some idea as to what I may think of female pilots but I shall no doubt be dead before this three year old achieves her newest ambition..
I hope that such a connection, slim as it may be, will assuage the ire of those whose sense of place and propriety might best situate them on the other side of the Bosphorous in relation to their antecedents, from whence they may wave forlornly at the Hellespont.
Thank you one and all.
cc.
Plastic PPRuNer
Originally Posted by TheFlyingPhysio
....if she limps barefoot then it is unlikely to be a shoe problem.
In a nutshell it appears to be a movement problem.
In a nutshell it appears to be a movement problem.
Originally Posted by TheFlyingPhysio
Solution. See a movement specialist i.e. a good physiotherapist.
Cheaper than a orthopod and more likely to offer a practical approach.
Cheaper than a orthopod and more likely to offer a practical approach.
Mac
PS: As part of an orthopaedic oncology team I regularly reconstruct legs, pelvises and whatnots after bone tumour resections.
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What a relief you figured the shoe problem out but why potentially scare the patient and the patient's family with nasties when a lot of simple things can be eliminated first. The physio, more often than not, has far greater experience at looking at limps and other apparent musculoskeleatal problems than the GP or junior hospital doctors for that matter.
Now, I don't disagree that movement problems can be due to nasties BUT you do physios a disservice by suggesting we are not competent to recognise scope of practice. Although I cannot state the case for South African physios, Aussie physios have had first contact rights for over 30 years and in the UK it has been at least 25 years. We do appreciate when the symptoms and signs do not fit a mechanical problem and are more than happy to refer on for a specialist diagnosis. In fact physios in the UK now work in Orthopaedic Clinics (as well as others e.g. Rheumatology) so that the valuable time of Orthopods is put to better use ! The results to date show that clinic throughput has been improved and waiting times to see the Orthopod reduced.
Finally, I would humbly suggest you note Chap 63 Grieve's Modern Manual Therapy 2nd Ed. The Vertebral Column edited by Boyling and Jull and published by Churchill Livingstone in 1994. You would be surprised to see what physios pick up and send back to the GPs or other specialists for their opinion.
Move well. Stay well. The Flying Physio
Now, I don't disagree that movement problems can be due to nasties BUT you do physios a disservice by suggesting we are not competent to recognise scope of practice. Although I cannot state the case for South African physios, Aussie physios have had first contact rights for over 30 years and in the UK it has been at least 25 years. We do appreciate when the symptoms and signs do not fit a mechanical problem and are more than happy to refer on for a specialist diagnosis. In fact physios in the UK now work in Orthopaedic Clinics (as well as others e.g. Rheumatology) so that the valuable time of Orthopods is put to better use ! The results to date show that clinic throughput has been improved and waiting times to see the Orthopod reduced.
Finally, I would humbly suggest you note Chap 63 Grieve's Modern Manual Therapy 2nd Ed. The Vertebral Column edited by Boyling and Jull and published by Churchill Livingstone in 1994. You would be surprised to see what physios pick up and send back to the GPs or other specialists for their opinion.
Move well. Stay well. The Flying Physio
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Originally Posted by TheFlyingPhysio
why potentially scare the patient and the patient's family with nasties when a lot of simple things can be eliminated first.
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Originally Posted by BelfastChild
why not get an xray when a lot of nasties can be eliminated first?
Plastic PPRuNer
TFP, I have the greatest respect for physios and work very closely with them in all my reconstructive work. They are skilled and dedicated paramedical colleagues. I couldn't do my thing properly without them and they have often given me valuable insights into difficult problems.
"The physio, more often than not, has far greater experience at looking at limps and other apparent musculoskeleatal problems than the GP or junior hospital doctors for that matter."
You may well be right there, especially with junior doctors, though I'd expect an experienced GP would also have adequate knowledge.
I'm not familiar with "first contact rights" but presumably you mean that patients contact physios first before being referred on to GPs or specialists as required. Well, people do that here too, but I'm a little uneasy with the idea that physios should be the first-line referral point for people with musculoskeletal symptoms. While I appreciate that many of these will be strains and sprains that respond to physiotherapeutic measures, a significant number are not and will not. By the time that your treatment has failed and the patient has been referred onwards, significant time may have been lost. Are you really comfortable performing a medical diagnostic function which your training, no matter how admirable, is not primarily directed towards? Are you sure that you would pick up, say, a slipped capital femoral epiphysis in an adolescent with knee pain? Being untrained in physiotherapy, I certainly would not attempt to usurp your functions.
I don't suggest that physios in general are not competent to recognise scope of practice, but merely point out that when the borders of scope of practice start to become blurred, that it is easy to find oneself in tiger country.
No one is perfect, we often see serious musculoskeletal pathology whose early symptoms have been dismissed by medically qualified people - not infrequently, I may add, because an X-ray has not been requested or the report not looked at.
Finally, though I have not read the publication you refer to, I am not in the least surprised at "what physios pick up and send back to the GPs or other specialists for their opinion" for I frequently see such patients.
"The physio, more often than not, has far greater experience at looking at limps and other apparent musculoskeleatal problems than the GP or junior hospital doctors for that matter."
You may well be right there, especially with junior doctors, though I'd expect an experienced GP would also have adequate knowledge.
I'm not familiar with "first contact rights" but presumably you mean that patients contact physios first before being referred on to GPs or specialists as required. Well, people do that here too, but I'm a little uneasy with the idea that physios should be the first-line referral point for people with musculoskeletal symptoms. While I appreciate that many of these will be strains and sprains that respond to physiotherapeutic measures, a significant number are not and will not. By the time that your treatment has failed and the patient has been referred onwards, significant time may have been lost. Are you really comfortable performing a medical diagnostic function which your training, no matter how admirable, is not primarily directed towards? Are you sure that you would pick up, say, a slipped capital femoral epiphysis in an adolescent with knee pain? Being untrained in physiotherapy, I certainly would not attempt to usurp your functions.
I don't suggest that physios in general are not competent to recognise scope of practice, but merely point out that when the borders of scope of practice start to become blurred, that it is easy to find oneself in tiger country.
No one is perfect, we often see serious musculoskeletal pathology whose early symptoms have been dismissed by medically qualified people - not infrequently, I may add, because an X-ray has not been requested or the report not looked at.
Finally, though I have not read the publication you refer to, I am not in the least surprised at "what physios pick up and send back to the GPs or other specialists for their opinion" for I frequently see such patients.
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Originally Posted by TheFlyingPhysio
So you want to shoot first ? Why not use some clinical reasoning before subjecting someone to radiation ?
In general, ANY young child with an unexplained limp should have an AP pelvis xray. It is **** all radiation. I think that not doing an xray in a young child with an unexplained limp constitutes medical negligence. I am sure a lot of my colleagues would agree.
FTP - I would be more than happy for a physio to take over management of the child AFTER I have excluded any serious pathology.
Plastic PPRuNer
Originally Posted by BelfastChild
In general, ANY young child with an unexplained limp should have an AP pelvis xray. It is **** all radiation. I think that not doing an xray in a young child with an unexplained limp constitutes medical negligence. I am sure a lot of my colleagues would agree.
Mac
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Originally Posted by cavortingcheetah
A friend of mine, caught up in the National Health in England, has a three year old grand daughter who has suddenly developed a pronounced limp.
This cause her no pain and her GP say: 'She's putting it on.'