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Treating Gait Abnormal Walking in Children

Watching a baby learn to walk makes it clear that our gait changes significantly as we age.  Gait refers to the way that a person walks, and there are a set of standards used to signify a range of normal.  Babies wobble, and often have a wider stance as they learn to balance during walking.  However, for some children, an abnormal gait carries over into the toddler years.

What are some common gait abnormalities in children?

In-toeing and out-toeing are the most common concerns seen among toddlers.  It’s very common for children in this age group to angle their feet either in (also referred to as pigeon-toed) or out.  While it may trouble parents to see these gait concerns, children experience no pain from them, and most see improvement as they age.

What causes in-toeing and out-toeing?

The most common reason for these gait abnormalities is that the bones of the leg are rotated.  For instance, in-toeing is usually caused by tibial torsion, which means that the tibia (or lower leg bone) angles inwardly.  If it angles outward, then out-toeing is the result.  Femoral anteversion can cause the same problems due to a turning in or out of the thigh bone (femur) which then impacts the tibia.  Also, if a child’s foot curves, in-toeing can result.  This foot curvature is known as metatarsus adductus.

Why does my child have a gait abnormality?

There are no clear answers regarding the exact reasons that some children develop in-toeing or out-toeing while others do not.  Some professionals suggest that these childhood gait abnormalities may run in families.  If possible, find out if you or your siblings experienced an unusual gait as children.  This may help your doctor to understand the family history, and assess the likelihood that your child’s gait will improve as they get older.

Another theory regarding these gait concerns is that limited space in a mother’s womb may lead to out-toeing or in-toeing.  Space is limited, and as a baby grows inside his mother the bones of the leg may turn to fit within the confines of the womb.  In this case, seeing the child learn to walk will give tell-tale signs that turning of the bones of the leg and the feet have occurred.

What should I do if I notice that my child is either in-toeing or out-toeing?

Many parents will see improvement as their child grows, and becomes a more experienced walker.  Children gain greater control over their gait as they mature, and often the bones of the leg will go back to the appropriate angle.  As a parent, it may be helpful to use video to document your child’s gait on a yearly basis.  This will assist you in noting changes and improvements as your child ages.  Most likely, you will see that your child’s gait has improved.  However, if you see that it hasn’t, you should discuss your concerns with your child’s doctor to determine the best course of action.

Some basic guidelines that are used to decide when it’s time to seek medical intervention include:

  • Reports of pain
  • Gait concerns that are getting worse and not better
  • Limping
  • Persistent in-toeing or out-toeing beyond age 3
  • Imbalances:  one foot that angles more than the other
  • Delays in development such as talking

In some cases, gait abnormalities can indicate neuromuscular conditions, so it is important to seek a podiatrist’s advice to determine if further testing is needed.

Are there other gait abnormalities that show up in children?

Limping and toe-walking are two other gait concerns that appear in children.  Toe-walking is much less common, and when it occurs past age three is often related to muscles that are tight.  However, it can indicate serious conditions such as cerebral palsy.

Limping is most often a reaction to pain (a blister, sprain, etc.), which are a normal part of life.  However, limping when pain is not present can indicate an issue that is developmental or neuromuscular in nature. cited

Seeking Treatment

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