Acute refusal to weight-bear or limp is a commonly encountered presentation to the Paediatric Emergency Department (PED). Due to the extensive range of differential diagnoses that may be responsible for these symptoms in the paediatric population, such patients pose a diagnostic challenge. Furthermore, some of the potential causes can be extremely serious or even life-threatening. POCUS has been demonstrated to be useful in assisting and expediting decision making for paediatric patients presenting with lower limb complaints in the PED. This article describes a range of acute lower limb presentations to the PED in which POCUS played a central role in establishing the diagnosis, which was otherwise unclear or assisted as part of its management.