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What's Affecting Your Child's Gait?

When you look at a child first learning to walk, you’ll notice they don’t move like adults do. They plant their feet more widely apart, take shorter steps, and move more rapidly. All of this is a normal part of development. It’s not until they reach about 3 years old that their gait resembles an adult’s. It’s important to keep this in mind when thinking about what’s normal and what’s not.

However, a number of conditions can occur, from a structural problem or an underlying medical condition, that prevent children from walking normally as they grow, and it’s important to understand what’s causing them so you can know what to do about them.

Here at MidJersey Orthopaedics, with offices in Bridgewater, Flemington, and Washington, New Jersey, our expert team of orthopaedic surgeons, sports medicine physicians, and podiatric specialists can help you make sense of what might be affecting your child’s gait, and when, or if, an intervention is necessary. Here’s what you need to know.

Common pediatric gait issues

Gait abnormalities are divergences from what’s considered the normal walking cycle for a child in a particular age group. Many are common developmental issues and correct themselves without any medical assistance. The four most common types are:

  1. Intoeing: feet point inward
  2. Outtoeing: feet point outward
  3. Toe-walking
  4. Limping

Intoeing and outtoeing generally don’t cause the child pain, and they don’t interfere with learning to walk normally. In fact, most outgrow the condition on their own, without any special intervention.

The most common reasons for intoeing and outtoeing include:

Tibial torsion

Tibial torsion occurs when your child's lower leg bone (the tibia) turns either inward or outward. The condition usually improves on its own, generally before the age of 4, but the doctor may occasionally recommend a night brace for children 18-30 months old. Surgery is indicated only if your child is at least 8-10 years old, and the problem has persisted, resulting in significant walking difficulties.

Femoral torsion

Femoral torsion occurs when your child's upper leg bone (the femur) turns either inward or outward. Intoeing from femoral torsion worsens when your child’s between 2 and 4 years old, and it’s most apparent around 5-6 years old. However, it can improve without medical intervention. Surgery is indicated only if your child is older than 9 years, trips a lot from uncoordinated walking, and has an unsightly gait.

Bowlegs and knock knees

Young children display a wide range of knee alignments, and this is normal. Both bowlegs and knock knees usually straighten themselves out as your child grows.

However, bowleggedness beyond 2 years old or that affects only one leg can be the sign of an underlying problem, such as rickets or Blount disease.

Rickets is a bone growth problem usually caused by a lack of vitamin D or calcium in the body, and can almost always be corrected by adding the two to the child’s diet.

Blount disease causes abnormal growth of the top of the tibia in the lower leg. Its cause is unknown, but it can usually be corrected by bracing or surgery when the child is 3-4 years old.


Flatfeet are completely normal in infants and young children, as the foot arch doesn’t develop until the child reaches at least 5 years old. For children who don't develop a full arch after that point, arch supports can help reduce any potential pain.


Limping is an entirely different matter. Sudden limping most likely results from pain due to a minor and easily treated injury, such as splinters, blisters, or tired muscles. Sometimes, though, the cause can be more serious, such as a sprain, fracture, dislocation, or joint infection, so you should have your pediatrician evaluate it.

During the evaluation, the doctor will try to distinguish between limping that’s painful — likely  caused by a minor injury — and limping that’s not. Non-painful causes can result from a developmental problem such as hip dysplasia, or a neuromuscular problem such as cerebral palsy.


Toe-walking is common in children under 3 and usually corrects itself. Toe-walking in older children or on only one leg might be linked to other conditions, such as muscle weakness disorders, leg length discrepancy, autism, or nervous system problems.

If the child is otherwise healthy, the doctor might prescribe some physical therapy to learn stretching exercises. When the child reaches 4-5 years old, casting the foot and ankle for six weeks or so may help stretch the calf muscles appropriately.

Is your child showing signs of an abnormal gait? Contact MidJersey Orthopaedics to have them evaluated before the problem becomes entrenched. You can give us a call at any of our locations, or schedule a consultation online.

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