Walking (gait) abnormalities
Common types of gait abnormalities include Intoeing and outtoeing:
If your child's feet point inward instead of pointing straight ahead when walking or running, it's called intoeing. Out-toeing means that the feet curve outward instead of pointing straight.
- Intoeing and outtoeing are the most common gait disturbances that cause parents to seek advice from their child's doctor
- Most children outgrow the condition naturally and don't need special shoes, stretching exercises or special casts, braces or surgery
- Infants and toddlers with intoeing and outtoeing can go barefoot without causing problems to the feet
- Intoeing and outtoeing usually don't cause your child pain and don't interfere with the way your child learns to walk
What causes intoeing and outtoeing?
The most common conditions that can cause a child's foot or feet to curve inward or outward include:
- Tibial torsion is the turning of your child's lower leg (tibia) either inward (internal tibial torsion) or outward (external tibial torsion)
- The condition improves without treatment, usually before age 4
- Consider surgery only if your child is at least 8 to 10 years old, and the problem has persisted, causing significant walking problems
- Occasionally, a brace is used at night in children 18 to 30 months of age
- Femoral torsion is the inturning or outturning of your child's upper leg bone (femur). It's most apparent when your child is about 5 to 6 years old.
- The condition improves without treatment
- 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 and 4 years of age
- These conditions 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
- The arch develops in your child's foot until at least age 5
- Flatfeet are normal in infants and young children
- This 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, and newborns with Metatarsus adductus 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 to 9 months
If your child is suddenly limping, it's most likely due to pain caused by a minor, easily treated injury.
- 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
- Toe-walking is one of the least common gait abnormalities
- After age 3, if your child walks on his or her toes, they need careful evaluation by a physician
Most cases of persistent 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 be a sign of developmental dysplasia of the hip or leg length discrepancy.