 Gait Abnormalities
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In the first few years of life, a child's normal gait, or walking cycle doesn't resemble that of an adult. A normal 1-year old, for example, has a wide-based stance and rapid cadence and takes short steps. In fact, it's not until a child is around 3-years old that clear adult gait patterns are detectable in a child. However, during the early years, there can be some obvious gait abnormalities-any number of disturbances in what is considered the normal walking cycle for that age group-that may become a concern. While many of these disturbances are quite common and correct themselves on their own, some require medical assistance. The most common types of gait abnormalities, discussed further below, are in-toeing out-toeing, limping and toe walking.
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The diagnosis of a gait abnormality is made during a physical examination by your child's physician. The doctor will carefully observe your child as he or she walks or runs. During the examination, the physician obtains a complete prenatal and birth history of the child and asks if other family members are known to have any gait abnormalities.
Depending on the type of gait abnormality and its suspected cause, other diagnostic procedures may include:
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- X-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- computed tomography (also called CT or CAT scan) - diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called "slices"), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
- magnetic resonance (MR) imaging (also called MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
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The following are the most common types of gait abnormalities:
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Intoeing means that the feet point inward instead of pointing straight ahead when walking or running. Out-toeing means that the feet curve outward instead of pointing straight. These are the most common gait disturbances that cause parents to seek advice from their child's doctor. If your young child has either of these walking patterns, he or she will probably outgrow the condition naturally. You don't need special shoes, stretching exercises or special casts, braces or surgery, in most cases. Infants and toddlers with in-toeing and out-toeing can go barefoot without causing problems to the feet.
Severe intoeing or outtoeing may cause your child to stumble or trip. Other facts you should know include:
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- Intoeing and outtoeing usually do not cause your child pain.
- Intoeing and outtoeing usually do not interfere with the way your child learns to walk.
- Neither problem has been linked to degenerative arthritis in adulthood.
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The following are the most common conditions that can cause a child's foot or feet to curve inward or outward:
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- Tibial torsion is in-turning of your child's lower leg (tibia) either inward (internal tibial torsion) or outward. (external tibial torsion). In the womb, the legs were in a confined position. Tibial torsion means they didn't rotate into the turned out position after birth. The condition improves without treatment, usually before age 4. Splints, special shoes and exercise programs don't help. Consider surgery only if your child is at least 8-10 years old, and the problem has persisted, causing significant walking problems. Occasionally, a brace is used at night in children 18-30 months of age. For more information, see Tibial Torsion.
- Femoral torsion is the in-turning or out-turning of your child's upper leg bone(femur). It's most apparent when he or she is about 5-6 years old. Doctors don't know why femoral torsion happens. It gets better without treatment. Modified shoes, braces and exercises don't help. Consider surgery only if your child is older than 9 and has a very severe condition that causes a lot of tripping and an unsightly gait. Intoeing from femoral torsion becomes worse between 2 ad 4 years of age.
- Bowlegs and knock-knees usually straighten out as your child grows. A wide range of knee alignment is normal in young children. Special shoes and wedges don't help either condition.
- Flatfeet are normal in infants and young children. The arch develops in your child's foot until at least age 5. You don't need special wedges, inserts or heels.
- Metatarsus adductus is a common birth defect in which your child's feet bend inward from the middle to the toes. In severe cases, it may resemble clubfoot deformity. The condition improves by itself most of the time. That's why most newborns with it are not treated until they're at least several months old. Treatment usually involves special exercises, applying casts or special corrective shoes and has a high rate of success in babies aged 6-9 months.
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If a child is suddenly limping, (walking with an unsteady gait, favoring one leg), it is most likely due to pain caused by a minor, easily treated injury. Limping can be caused by pain anywhere along the leg. Splinters, blisters, or tired muscles are common culprits, but sometimes limping can involve a more serious problem such as a sprain, fracture, dislocation, joint infection, arthritis or, less commonly, a tumor. While evaluating your child, the doctor will try to distinguish between painful limping and non-painful limping. Non-painful chronic limping may be indicative of developmental problem, such as developmental dysplasia of the hip or neuromuscular problem, such as cerebral palsy. For more information on how these conditions are diagnosed and treated, see entries on these topics.
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Toe-walking is one of the least common gait abnormalities. If your child walks on his or her toes, and it under 3 years old, the problem can be normal, but after age 3, if the problem persists, it requires careful evaluation by your child's physician. Most cases of persistant toe-walking are familial or are simply secondary to tight muscles. Treatment may involve observation, physical therapy, casting or surgery. Toe-walking may indicate a neuromuscular disorder such as cerebral palsy or it could denote developmental dysplasia of the hip or leg length discrepancy (if it involves one foot only). For more information on how these conditions are diagnosed and treated, see entries for these topics.
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