consider. Slipped capital femoral epiphysis Slipped capital femoral epiphysis (SCFE) is a condition in which the growth plate of the head of the femur slips over the underlying bone. It most commonly presents with hip pain in males during puberty and is associated with obesity. The majority of people affected have a painful limp and in half of cases both hips are affected. Nearly a quarter of people present with only knee pain. Treatment involves non-weight-bearing movement and surgery. If not identified early, osteonecrosis or death of the head of the femur may occur. Other A non-painful limp may be due to a number of mechanical conditions including hip dysplasia and leg length differences. Inflammatory Transient synovitis Transient synovitis is a reactive arthritis of the hip of unknown cause. People are usually able to walk and may have a low grade fever. They usually look clinically nontoxic or otherwise healthy. It may only be diagnosed once all other potential serious causes are excluded. With symptomatic care it usually resolves over one week. Juvenile rheumatoid arthritis Juvenile rheumatoid arthritis presents gradually with early morning stiffness, fatigue, and weight loss. Vascular Legg–Calvé–Perthes syndrome Legg–Calvé–Perthes syndrome is a degenerative disease of the head of the femur which results in bone loss and deformity. It usually presents as a chronic condition. Neoplastic Cancers including acute lymphocytic leukemia, osteosarcoma, and Ewing’s sarcoma may result in a gradual onset of limping in children. It is often associated with night sweating, easy bruising, weight loss, and pain most prominent at night. Diagnostic approach The diagnosis of the cause of a limp is often made based on history, physical exam findings, laboratory tests, and radiological examination. If a limp is associated with pain it should be urgently investigated, while non-painful limps can be approached and investigated more gradually. Young children have difficulty determining the location of leg pain, thus in this population, knee pain equals hip pain. SCFE can usually be excluded by an x-ray of the hips. An ultrasound or x-ray guided aspiration of the hip joint maybe required to rule out an infectious process within the hip. Epidemiology A limp at one hospital emergency department was the presenting complaint in 4% of children. It occurs twice as commonly in boys as in girls. References External links Gait abnormalities