Gait

child; walking; feet; leg; gait; bandy; shoes; in-toeing; out-toeing; limping; flat; medial; arch; knock; knee; bow; development; walk; walking; balance; toenail; toenails; limp;

Contents

• What is gait?
• Learning to walk
• What affects gait?
• In-toeing
• Out-toeing
• Limping
• Flat feet
• Knock knees
• Bow legs
• Remember
• Shoes
• What parents can do
• References

When children first start walking it takes some time before they learn to walk in the same way as older children and adults. For example they first walk with their legs wide apart for balance.

Parents often worry about the way their children walk, especially young children and wonder whether it is "normal". In most cases differences in the way children walk are part of normal development and will correct themselves as the child grows.

What is gait?

Gait is the term used to describe the way people walk.

Learning to walk

• Learning to walk is a combination of skills that takes time and practice to learn.
• They include learning to balance in many positions, learning to stand upright, shifting weight over the leg that is supporting the body and coordinating muscles.
• Taking a step forward means that the child must shift the weight to the supporting leg from the stepping leg, then back to the stepping leg, and the child needs to have good muscle control.
• When children first walk it looks like a waddle. This is because the legs are wide apart to begin with and there is movement from side to side.
• It takes a several months for the toddler gait to develop into a more mature walking pattern.
• There is quite wide normal variation between children in walking and running skills in the first five years of life.

What affects gait?

• Leg shapes and ways of walking vary with age, family tendencies (heredity), and for some babies the way they were "packaged" in the womb (uterus).
• When babies first start to take weight on their feet they appear to have no foot arch due mostly to a pad of fat under the foot. By 4 or 5 years of age the arch has usually appeared and the pad of fat has disappeared.
• During the first year of life many babies' legs have a naturally "bowed" or "bandy" appearance which may last until the second or third year. Only a small number are severe enough to need any treatment. See 'Bow legs' below.
• Other infants may develop a knock-kneed appearance. This is less common. This usually disappears by 7 or 8 years of age. See 'Knock knees' below.
• If there is a sudden change to a child's gait (a limp), it may mean a recent injury. You should check with a doctor to make sure there is no other underlying cause.
• There are some diseases and other problems that can affect bones, muscles, joints or tendons. Many of these can be corrected with early treatment, so if you are worried about your baby or young child it is important to have a check with a doctor or a physiotherapist or podiatrist who specialises in working with children.

In-toeing

Intoe-ing is walking with one or both feet turned inwards. It may correct itself without any treatment by the time the child is about three. You should see an orthopaedic specialist, a children's physiotherapist, or children's podiatrist if the problem is severe or has not improved by 18 months to 2 years, or if you are worried about it. They can check whether it is caused by a problem with the hips, leg bones or feet and give you ideas about how to help your child.

Out-toeing

This is when the child walks with feet turned outwards. This is rare. It can happen sometimes in babies who have been premature. It should be checked by a specialist.

Limping

This usually happens after an injury but can be caused by other problems and you need to have it checked by your doctor to work out the cause.

Flat feet

This is when there is no arch along the inner side of the foot (medial arch). In babies it is normal to have no visible medial arch (the arch is there but it is hidden by a fat pad). If it goes on into childhood it only needs treatment if it is affecting the normal development and movement of the feet and legs. However in some severe cases, treatment is needed so if you are worried have it checked.

There is a wide range of what is normal and a specialist (orthopaedic specialist, a children's physiotherapist, or children's podiatrist) can work out what is the problem and the best way to manage it.

Knock knees

Some degree of knock knees can be normal up to four or five years of age, and will disappear by about seven years. If the child is very overweight the problem may be worse and take longer to go away. Knock knees should also be checked by a specialist.

Knock knees is common between the ages of 2 years and 7 years.  About half of normal 3 year old children have 2.5-5 cm (1-2 inches) between the ankles and about one in four  have more than 5 cms (2 inches).

 

Bow legs

Children may have the appearance of having bow legs until they are about two or three. In older children it is unusual and should be checked. The child often in-toes as well.

 

Remember 

• There are wide variations in gait (ways of walking) which are still normal.
• There is a wide time range for starting to walk - from 8 to 18 months or more can all be normal.
• Early treatment can correct most gait problems in children. If you are concerned have your child checked by an orthopaedic specialist, a children's physiotherapist, or children's podiatrist.

Shoes

There is no need to buy shoes for toddlers until they are walking well - usually 6-8 weeks after they begin walking. Bare feet are better for inside, and for outside when it is safe to be barefoot.

Barefoot walking helps to develop the small muscles of the foot.

When choosing shoes look for a strong heel and good support over the front of the foot, with plenty of room to grow - about a thumb width. Make sure that socks fit well (not too tight) and that the feet in grow-suits have plenty of room at the end of the foot.

What you can do

• Make sure children have regular checks of feet and legs. The first check will usually be done by your doctor or paediatrician after the birth. Other checks are recommended at 18 months and 2½ - 3½ years.
• Give babies plenty of opportunity to kick their legs. This helps their muscles to develop.
• Always make sure that children's shoes fit well.
• Thongs are OK occasionally, but not for regular use.
• Encourage children to spend time barefoot where it is safe.
• See your doctor if your child has pain in the feet (check that there is not a stone in the shoe, a splinter or ingrown toenail), legs, joints, back or hips, or if she fails to walk and run by two years of age.
• If you are at all worried have your child's problem checked. Sometimes only a specialist can tell whether it is something that is normal or if it needs treatment.

References

Broadhurst, Norm. (1996) "When tight muscles cramp style". Australian Doctor, 28^th June.

Chong, Andrew. (1986) "Is your child walking right?". Wheaton Resource Corp.

Little, David. (1997) "How to treat children's gait". Australian Doctor, 11 July.

Torode, Ian. (1996) "Postural abnormalities in childhood". Modern Medicine of Australia.

The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your
child's sex.