What are Gait Problems?

A gait problem is an umbrella term used to describe problems with a child’s walking pattern which may be caused by a number of different factors. In the first few years of life, a child’s normal walking pattern (gait) is different from that of an adult. A one-year-old, for example, has a wide-based gait with quick, short steps. When a child is around three years old their walking pattern starts to resemble that of an adult. Many parents become concerned that their child’s gait is abnormal, although very often it is age-appropriate or corrects itself without any help. However, if you have any concerns about the way your child walks, contact Therapies for kids for a physiotherapy assessment. We will be able to provide reassurance, exercises, or onward referral.

Types of Common Gait Problems

Intoeing (Pigeon Toes)

Intoeing means that when the child walks or runs, the feet turn inward instead of pointing straight ahead. There are 3 common causes of intoeing:

• curved foot -metatarsus adductus
• curved shin-  tibial torsion
• curved thighbone- femoral anteversion.

Intoeing is a common finding in babies and toddlers. In newborns, turning in of the front of the foot is called metatarsi adductus. It resolves spontaneously in the majority of children but stretches to the forefoot are often helpful. In more severe cases a light plaster cast can be applied for a few weeks, to keep the foot in a neutral position.

In toddlers, intoeing is often associated with internal rotation of the tibia tibial torsion. This presents as bow legs. This may also be a result of intrauterine positioning. It nearly always resolves spontaneously. Children with intoeing may trip a little when they first start to walk, but this will become less frequent with time. There can be cause for concern if there is asymmetry present or if the problem is not improving with time.  A referral to the appropriate specialist may be indicated.

In the older child, femoral anteversion occurs when a child’s thighbone (femur) turns inward. It is often most obvious at 5 to 6 and is commonly associated with W sotting.  Your child’s knees and feet turn inward on standing and walking.

Intoeing usually does not cause pain or interfere with the way your child performs motor skills.  Sometimes severe intoeing can cause young children to stumble or trip and this may respond to some exercises from a physiotherapist.

Tiptoe Walking

Tip-Toe Walking is when a child walks on their tiptoes rather than using their whole foot when walking. Many toddlers walk on their tip-toes, this usually improves by the time they start school.  If your child can stand with the feet flat, then the toe-walking habit will probably disappear on its own.

However, your child may need help if they have stiff ankles or feet (making it difficult for you to move the feet up or to put shoes on), rarely stand with the feet flat, or the toe-walking habit persists.

Knock Knees (Genu Valgum)

Knock Knees (genu valgum) is when a child’s knees rub or knock together but the ankles remain apart when walking. A child who stands with their knees touching but their ankles apart is said to have knock-knees. During childhood, knock-knees are a part of normal growth and development. Knock-knees usually become apparent when a child is two to three years old and may increase in severity until about age four. Concerns only really arise if the condition is first noticed after the child is six years old or if one leg is more affected than the other. If you are concerned taking photos every few months in standing will allow you to track the change in your child.  This usually shows improvement after 3 or 4.

What Therapies for Kids can do

If you have any concerns about the way your child walks, contact Therapies for Kids for a physiotherapy assessment. We will be able to provide reassurance, exercises, or onward referral.

The physiotherapists at Therapies for kids are experienced in musculoskeletal assessment and help to establish reasons behind types of gait problems such as muscle imbalance, tightness or weakness, and joint stiffness.

If your child has any issues identified on assessment treatment may include:

• stretches for any muscle imbalance
• strengthening exercises
• advice in sitting positions
• advice on motor skill acquisition if any delays  provision of a home programme
• inclusion in one of our Fizzy Gym classes if indicated
• advice on shoe wear
• referral to a podiatrist if necessary advice on further referral to a medical specialist if indicated.

What you can do

If you have been advised to alter your child’s sitting position you can give them reminders and praise when they adopt the new position.  You can assist them with stretches and any strengthening exercises at home and provide opportunities for them to perform physical activities as part of their daily routine.