By Carrie A. Lakin, DPM, AACFAS
I am often asked to evaluate the gait (walking pattern) of small
children. Parents usually report that they mentioned this problem
to their pediatrician at some point, and were told that the child
would “grow out of it”. Simple observation became the
treatment, despite the child’s increasing trips and falls. In
some cases, parents describe their child as refusing to “come
down off their toes”! There is much debate about this very subject
between differing groups of specialists. To make matters somewhat
more questionable is the different rates at which “normal”
children develop.
We know that there is a time line for baby’s to crawl and walk
but many perfectly normal children are doing so at certain time intervals
in their lifespan. How do we know when our children are on schedule?
Can we be missing an opportunity to treat some of these problems by
relying upon simple observation alone? The answer, is just as clear,
yes and no!
A famous article was published many years ago by a pediatric orthopedist
that declared that roughly 90 % of walking abnormalities are normal
physiological changes in the bone structure of our small children.
For example, in-toeing, or walking with the toes pointed inward, is
commonly seen during the 2-4 year old stage, and especially in the
females. It usually regresses by age 7-8 years, and often the children
can trip while running until this problem corrects itself naturally.
The same could be said for out-toeing, or walking with the toes pointed
outward. It is normal for infants to begin walking like this, with
a broad base of support underneath them. As they reach age 2 their
limbs rotate inward at the ankle area and they start to walk a straight
line. As you can see, the child’s gait goes through constant
change as the bones adapt and grow, which continues into adolescence.
A general rule of thumb is this…
• Toe walking is always abnormal, sometimes habitual, and should
be evaluated for further problems by a qualified specialist.
• By the age 8 the child’s feet should progress fairly
straight, or slightly outward. The arches of the feet should be apparent
while standing.
• Curvatures of an infant’s foot, a “c” shaped
foot, should be examined by a specialist early in life. Often this
is an easily treatable condition known as Metatarsus Adductus, which
responds nicely to stretching and serial casting of the legs and feet
for 1-2 months.
My last peace of advice….relax… most likely your child’s
walking and bone structure are normal! Don’t be afraid to seek
a professional opinion if you have concerns, if for no other reason
than the peace of mind. But remember, one cannot always expect a treatment
plan! Sometimes observation is the best treatment!
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