Gait Irregularities: Information For Parents

What Parents Think iAs Abnormal, When It's Really Normal:

Toddlers walk with a wide-based gait, especially if diapered, and little arm swing, with little ground clearance, and a mild foot drop. All of these are normal in the first 3 to 6 months of walking.
When toddlers hurry, they don't take longer steps, but instead walk faster, leading to increased trips and falls.
Toddlers knees are closer to their ankles than in older kids and adults, make milk torsional (or twisting) irregularities more obvious
Toddlers seldom walk in a straight line...they're are always twisting, turning, leaning, & over-balancing
Toddlers appear bowlegged until 18 to 24 months. Children's legs then straighten out temporarily, then become knock-kneed to some degree by age 3, until as old as age 7!

To summarize, an adult-like gait is not reached until around age 3!

What Is In-Toeing?

In-toeing is almost always normal, especially when beginning to stand, and peaks during cruising and then early walking. Very few children need treatment.

A common cause of in-toeing is Medial (or Internal) Femoral Torsion. This is where the femur , the bone between the hip & knee, twits inward, causing both the knee & foot to turn in when walking. These children prefer to sit in the "W" position, which prevents correction. Most children have some degree of femur twists, especially girls, but it almost always improves by age 7. Even if not, the in-toeing rarely slows down an athlete, or cause hip or knee arthritis. The only therapy is discouraging the "W" sitting position, encourage the "lotus" sitting position, and encouraging sports that promote the feet to turn outward (skating, ballet, dance, skiing, gymnastics). Special splints do not work. Only if the in-toeing is severe past age 10 will other options be considered.

A less common, but still generally benign, cause of in-toeing is Metatarsus Varus, or an inward-turning foot. The sole of the foot appears "bean-shaped". As long as the doctor makes sure that the foot is still fully flexible, and the baby sleeps on it's back or side, this almost always corrects without therapy. A baby who sleeps on it's tummy, or one whose foot is not flexible, may be sent to an orthopedist for special corrective shoes or splints for 1 to 2 months. Severe cases may require a series of casts.

Another somewhat common cause of in-toeing is Internal Tibial Torsion, where the tibia (shin bone) twists inward. Children with this problem often are noted to sit or sleep on their feet. most children with is condition resolve by age 5; splinting is not effective unless done for severe torsion recognized in the first 6 to 9 months of life. For older kids, therapy consists of discouraging this sitting or sleeping position, and again, encouraging the lotus sitting position. This type of in-toeing actually it advantageous for runners & sprinters! It dose not lead to arthritis.

Very rarely, in-toeing represents one of many signs of a disease such as Spina Bifida, Cerebral Palsy, or Polio. Our evaluation will make sure to eliminate these remote possibilities as causes of your child's in-toeing.