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Gait - the way children walk

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;

Gait is the word used to describe the way people walk. Parents often worry about whether the way their child walks is normal. Often the way the child is walking is normal for their age and will change as they get older.

When children first learn to walk they do not walk in the same way as older children or adults. For example, they walk with their legs wide apart for balance, and their legs may not seem as straight as older children.

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Learning to walk

Learning to walk uses many skills, and takes time and practice. These skills include learning to balance, learning to stand upright and to shift weight from one leg to the other. There is a wide range of ages at which children first learn to walk, from 8 to 18 months or more, and this is normal.

When children first walk it looks like a waddle. This is because their legs are wide apart to begin with, and there is movement from side to side. It takes several months for their toddler's gait to develop into a more mature walking pattern. Children's walking and running skills vary a lot in the first five years of life, and are usually normal for them.

There are some diseases and other problems that can affect bones, muscles, joints or tendons, and show up as unusual walking patterns. The information below will help you to work out what is normal development, and when children should be checked by a Paediatric Specialist, such as a doctor or physiotherapist who works with children.

Bow legs / knock knees

As children grow the line of their legs naturally changes. Babies are born with bow legs, but this is generally not noticed until they start to walk. Once the child is walking the legs begin to straighten.

By 3 years of age children often have a knock kneed appearance.  Knock knees are common in children 3-8 years of age. Usually their legs become straighter by 8 years of age.

When to seek specialist opinion regarding bow legs / knock knees:

  • Your child has a limp or complains of pain.
  • Bow leg or knock knee appearance of one leg only.
  • Bow legs / knock knees that are rapidly getting worse.
  • Bow legs that worsen after 3 years of age.

In-toeing / Out-toeing

In-toeing is walking with one or both feet turned inwards. It is common in childhood, and can cause children to trip and fall more often than other children. The in-toeing may be coming from the child's hips, leg bones or feet. Usually this becomes normal as the child grows older and no treatment is needed.

Out-toeing is when the child walks with feet turned outwards. This is less common than in-toeing, and if their feet turn out a lot they should be checked by a specialist.

When to seek specialist opinion regarding in-toeing / out-toeing:

  • If the feet turn out a lot and you are worried about it.
  • If the in-toeing is not improving by 18 months to 2 years.
  • If one leg is more in-toed / out-toed than the other.

Tip-toe walking

Toddlers often start walking up on their toes, and this usually changes in the first year of walking. Children who continue to walk on their toes as they grow should be checked by a specialist to work out the cause. The toe walking may be due to tight muscles in the child's legs, which can be helped with stretching exercises. Sometimes a short time in plaster casts can help to stretch the muscles and help the child to walk with flat feet.

When to seek specialist opinion regarding tip-toe walking:

  • Toe walking in children older than 18 months to 2 years.

Flat feet

Parents are often concerned when their child's feet appear flat, but for most children it is a normal part of their development. Children usually have low arches because they are loose-jointed and flexible, and their arches flatten when they are standing. When their feet are hanging free, or the child stands on tip toes the arches can usually be seen more clearly.

The appearance of flat feet is common in preschoolers due to fat pads hiding the arches of their feet. As children grow, these fat pads become smaller, and the arch can be seen more clearly.

Shoes and orthotics

When a child is learning to walk the feelings that they get from the soles of their feet are important. Children do not need shoes when they are inside until they have been walking for a couple of months, and then only to protect their feet from sharp objects. Barefoot walking helps to develop balance, posture and coordination, by strengthening the small muscles of the foot. It also helps to walk on different surfaces, such as grass and sand.

Shoes are of course important to protect feet from the cold and injury from sharp objects, but they should be flexible (bend easily) to allow the feet to move and become stronger.

For most children with flat feet, orthotics or special shoes are not needed to support their feet. Research has not shown that they make any difference for the children.  If children have very flat or rolled in feet, it may help to have shoes which have some arch support and a slightly stiffer sole.

Children with painful feet, or those who have difficulties with their gross motor skills (e.g. learning to walk, running and jumping) because their feet roll in may benefit from supports in their shoes, but these should only be used if recommended by a specialist.

It is not necessary to buy expensive shoes. They may last longer, but there is no evidence that they are better for your child.

When to seek specialist opinion regarding flat feet:

  • If the child's feet are very flat or roll in a lot, and you are worried about it.
  • When the feet are painful or stiff.

Limping

If a child who has been walking in a balanced way begins to limp, or the child says that a part of their leg is painful this needs to be checked by a doctor as there may be an injury or there may be a problem with a joint.

Club feet

A small number of children have what is commonly known as 'club foot' at birth. The correct name is congenital talipes equino varus (CTEV).  Congenital means occurring from birth.  Talipes means foot deformity. 

To find out more have a look at our topic Club foot.

Summary

Remember every child is different and your child's development may differ from other children of a similar age. Children learn to walk at different ages, and with different styles. Different patterns can cause concern, but are often a part of normal development. Where you are concerned, it is always best to have your child checked by a specialist.

Source of this information

Information in this topic was provided by the Physiotherapy Department, Women's and Children's Hospital, South Australia. 

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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.

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