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Walking (Gait) Abnormalities

  • Watch a 1 year old wobble around, and you'll see her gait, or walking cycle, doesn't quite resemble that of an adult. She'll have a wider stance, rapid cadence and short steps. In fact, it takes until around age 3 for kids to display clear adult walking patterns.

    • During your child's first few years walking, they may have obvious gait abnormalities—disturbances in what is considered the normal walking cycle for that age group
    • The most common types of gait abnormalities are intoeing, outtoeing, limping and toe walking
    • Many gait disturbances are common and correct themselves on their own
    • Gait disturbances rarely require medical assistance

    Orthopedic Center
    Boston Children's Hospital

    300 Longwood Avenue
    Fegan 2
    Boston MA 02115
    617-355-6021

  • 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

    • 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

    • 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

    Bowlegs and knock-knees

    • 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

    Flatfeet

    • The arch develops in your child's foot until at least age 5
    • Flatfeet are normal in infants and young children

    Metatarsus adductus

    • 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

    Limping

    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

    • 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.

  • How does a doctor know that my child has a gait abnormality?

    Your child's doctor will carefully observe your child as he or she walks or runs.

    Other diagnostic procedures may include:

    • X-rays – A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film
    • Magnetic Resonance Imaging (MRI) – A diagnostic procedure that uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves
    • Computerized Tomography Scan (also called a CT or CAT scan) – A 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
  • Many gait disturbances are common and correct themselves on their own. When they do require medical assistance, Boston Children's Hospital has trained specialists to offer your child the right type of intervention.

    For these conditions, we offer:

    Tibial torsion

    • A brace may be used at night in children 18 to 30 months of age
    • Your child's doctor may consider surgery if the problem has caused significant walking problems and your child at least 8 years old

    Femoral torsion

    • Your child's doctor may consider surgery if the problem causes a lot of tripping and an unsightly gait, and your child is at least 9 years old

    Metatarsus adductus

    • 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

    Toe-walking

    • After age 3, if your child walks on his or her toes, they need careful evaluation by a physician
    • Treatment may involve observation, physical therapy, casting or surgery
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