7 possible problems with your toddler’s gait

Does your little one have bowed legs or flat feet? Find out when to worry and what to do.

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Most children take their first steps around their first birthday, although there’s a very broad range among kids who reach this milestone. Indeed, learning to walk takes a lot of practice, so it can go on for a long time. When your child masters this skill, it is a major advance in their effort to become more independent.

Worried about the way your child walks? Here’s what you need to know:

1. Flat feet (Pes planus)

This condition occurs when the arch of the foot is flattened and in contact with the floor. It’s common in toddlers as they have a larger fat pad and the arch is not formed yet.

“Flat feet is common up to the age of 10, as the bones and joints are flexible at this stage,” says Supapong Supantamart, a senior podiatrist at the National University Hospital Rehabilitation Centre. “The soft tissues gradually tighten and start to form arches of the feet once children grow older,” he adds.

Flat feet can be caused by neuromuscular disorders, injury, obesity, knock-knees and family history, says Ashlee Yoon, a podiatrist at the National University Hospital Rehabilitation Centre. Symptoms include flexible floppy feet, very low arch, and pain along the arch and heel. Flat feet usually “disappear” by the age of 7, but 10 to 20 per cent of children have this condition into adulthood.

How it’s treated: While no treatment is required, wearing shoes with arch support and a slightly stiffer sole may help. Severe cases may require surgery.

Flat feet can be caused by neuromuscular disorders, injury, obesity, knock-knees and family history.

2. Bowleggedness

This occurs when the child stands with his toes forward and ankles together with a distinct gap between the lower legs and the knees, says Yoon. Toddlers look bowlegged because they bend their knees to balance and support their body weight.

“Children who remain bowlegged after the age of 2 and whose condition is not resolving spontaneously should be assessed by a specialist,” advises Dr Lam Kai Yet, consultant at KK Women’s and Children's Hospital’s (KKH) department of orthopaedic surgery. “Possible causes may then include rickets, skeletal dysplasias or Blount’s disease,” he adds.

How it’s treated: In severe cases, surgery may be needed. “Surgical procedures range from growth modulation (insertion of small plates over the growth plates of the bones to redirect their growth) to corrective osteotomies (where bones are cut and then realigned surgically),” Dr Lam explains.

3. Knock-knees

This happens when a knee misalignment causes the knees to cave inwards, Yoon says. Knee pain is often linked to knock-knees, which may be caused by an underlying medical condition or flat feet.

In most cases, the legs gradually straighten by the age of 8. Physiotherapy, braces and strapping or foot orthotics can help improve posture and alignment, says Supapong. Orthotics refers to a foot device or support to relieve or correct an orthopaedic problem.

How it’s treated: Dr Lam says, “Surgical procedures for severe knock-knee cases are similar to those for bowleggedness.”

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4. In-toeing (Pigeon toes)

In-toeing happens when the child walks with one foot or both feet pointing inwards. Dr Lam says three conditions that lead to in-toeing are:

a. Increased bone rotations in the hip (femoral anteversion).

b. Increased bone rotations in the leg (tibial intorsion).

c. Increased bone rotations in the feet (metatarsus adductus).

How it’s treated: In some cases, stretching exercises or bracing and foot orthotics may be necessary, Supapong says. If junior is between 18 months and 2 years old with pain in the hips, knees and feet, see a specialist. “Avoid the W-sitting position as it causes the muscles around the hip and legs to become shorter and tighter,” Supapong explains.

“Avoid the W-sitting position as it causes the muscles around the hip and legs to become shorter and tighter."

5. Out-toeing

“Out-toeing is the reverse of the in-toeing condition,” says Dr Lam. “It refers to feet or toes that point outwards as the child walks,” he adds.
How it’s treated: No treatment required. When children enter adolescent stage, the bones gradually rotate back to a normal angle and the out-toeing gait improves over time, Supapong assures.

6. Walking on tip toe

This refers to children who walk on tip-toe. Yoon says this is due to tight calf muscles, neurological conditions, painful inflammation of the heel’s growth plate (calcaneal apophysitis). It’s also idiopathic (habitual).

How it’s treated: Seek help if junior is above age 3 and is unable to bear weight on a flat foot or falls frequently, Supapong advises.

7. Limping

Limping is often a reaction to pain, such as a sprain or blister. But if limping occurs without pain, it may indicate a developmental or neuromuscular issue.

Irritable hip (transient synovitis) is a common childhood condition that causes hip pain in children aged 3 to 10. It occurs when the lining that covers the hip joint becomes inflamed, although the cause of inflammation is unclear.

How it’s treated: See a GP to rule out septic arthritis and osteomyelitis, which is caused by a bacterial infection of the joint and bones.

8 footcare tips for your child

Senior podiatrist Supapong Supantamart offers advice on caring for your little one’s tootsies.

1. Get soft, non-slip rubber-soled footwear.

2. Choose shoes with breathable material, like leather or quality mesh.

3. Avoid open-toed shoes or flip-flops. These encourage toe-gripping, which leads to toe deformities.

4. Allow junior to walk barefoot to improve balance and coordination. Tickle his feet to flex the muscles.

5. Inspect feet often for blisters.

6. Dry wet feet, especially between the toes, to prevent infection.

7. Avoid using second-hand shoes as junior may risk contracting fungal infections.

8. Use baby nail clippers to trim toenails. Snip straight across, don’t cut or probe the sides of toenails as this may produce ingrown nails or an infection.

Photos: iStock

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