Differential Diagnosis for Leg Pain in an 11-year-old Male Dragging His Feet

Single Most Likely Diagnosis

• Muscular Dystrophy: This condition, particularly Duchenne muscular dystrophy, is a common cause of progressive muscle weakness and wasting in children, often presenting with a gait disturbance such as toe walking or dragging of the feet due to weakness of the hip and leg muscles.

Other Likely Diagnoses

• Cerebral Palsy: Although typically diagnosed earlier in life, some forms of cerebral palsy can present with progressive gait disturbances, including dragging of the feet, due to spasticity or muscle weakness.
• Peripheral Neuropathy: Conditions affecting the peripheral nerves can lead to muscle weakness and gait disturbances. In children, this could be due to various causes, including autoimmune disorders or inherited conditions.
• Orthopedic Conditions: Issues such as hip or knee pathologies (e.g., slipped capital femoral epiphysis, Perthes disease) can cause leg pain and alter gait, potentially leading to a dragging sensation.

Do Not Miss Diagnoses

• Spinal Cord Tumors or Compression: Conditions like spinal cord tumors or compression can lead to progressive weakness, pain, and gait disturbances. Early diagnosis is crucial for treatment and preventing further neurological deterioration.
• Guillain-Barré Syndrome: An autoimmune disorder that can cause rapid onset of muscle weakness, which may start in the legs and ascend. It's a medical emergency due to the risk of respiratory failure.
• Osteomyelitis or Septic Arthritis: Infections within the bone or joint can cause severe pain and lead to a limp or dragging gait. Prompt diagnosis and treatment are essential to prevent long-term damage.

Rare Diagnoses

• Charcot-Marie-Tooth Disease: A group of inherited disorders that affect the peripheral nerves, leading to muscle weakness and atrophy, primarily in the legs. It's less common in presentation with dragging of the feet in early childhood.
• Chronic Inflammatory Demyelinating Polyneuropathy (CIDP): A rare autoimmune disorder that can cause progressive weakness and potentially alter gait. It's less common in children but should be considered in the differential diagnosis of chronic or subacute neuropathies.
• Neurodegenerative Disorders: Such as Friedreich's ataxia, which can present with progressive gait ataxia and weakness, but typically includes other symptoms like dysarthria and loss of reflexes.